Differences of gastrointestinal bleeding after percutaneous coronary intervention with stent implantation among the different dual anti platelet therapies

Abstract

Abstract Patients who have undergone percutaneous coronary intervention (PCI) must be treated with dual antiplatelet therapy (DAPT) (aspirin and an adenosine diphosphate receptor antagonist (P2Y12)) to prevent thrombotic complications. However, this cornerstone of treatment comes with a higher risk of bleeding, which may have serious adverse outcomes, and affect the prognosis of patients. Gastrointestinal bleeding is one of the most common adverse consequences due to the direct injury that these drugs can cause in the mucosa of the digestive system. Old age, smoking, digestive tract diseases and renal impairment are risk factors for this kind of bleeding. However, the differences between DAPT options on the gastrointestinal injury have not been well studied. The primary objective was to compare the differences of the three different DAPT options in the incidence of gastrointestinal bleeding (defined according to CIE-9) in patients who presented with either acute or chronic coronary syndrome and have had an PCI with stent implantation. The influence of other variables in the incidence of gastrointestinal bleeding (including baseline characteristics of the patients, history of gastrointestinal diseases and other medications) and other complications, such as cardiovascular events and death, were secondary objectives. We conducted a retrospective observational cohort study, and all the patients who have undergone a PCI with stent implantation in two hospitals of our health system between January 2014 and December 2018 were enrolled. Clinical follow-up was the same time the patient was treated with DAPT. The information was extracted anonymously from the Oracle Business Intelligence Enterprise Edition (OBIEE) platform, which can integrate all clinical, analytical, diagnostic and prescription information. A propensity score adjustment was used with the risk covariates to form paired cohorts of each of the antiplatelet therapy groups. A total of 3367 patients were enrolled: 2052 in the clopidogrel group, 806 in the ticagrelor and 509 in the prasugrel group. 208 (6.18%) patients had a gastrointestinal bleeding: 132 (6.43%) in the clopidogrel group, 56 (6.95%) in the ticagrelor group and 20 (3.93%) in the prasugrel group (p=0.064). The baseline characteristics of the patients are listed in Table 1. We conducted a logistic regression to predict a multivariate model, in which, we observed that nine of the baseline characteristics are strongly related with the incidence of gastrointestinal bleeding. Moreover, according to our multivariate model, comparing with clopidogrel, the incidence of gastrointestinal bleeding seemed to be higher in the ticagrelor group (Odds Ratio [OR] 1.293, p=0.154) and lower in the prasugrel group (OR 0.661, p=0.111). There were not found significant differences in the incidence of gastrointestinal bleeding among the three options of DAPT in patients who have undergone a PCI with stent implantation. Funding Acknowledgement Type of funding sources: None. Table 1