Survival Outcome of Patients in Acute Variceal Bleeding With Acute Coronary Syndrome Discharged on Anti-Platelet Agents

Abstract

Introduction: Acute variceal bleeding is one of major and killing complication of advanced liver disease, and these patients are not immune from developing acute coronary syndrome. Data regarding outcome of patients with acute variceal bleeding with acute coronary syndrome is scarce. The aim of this study was to look for survival outcome of those patient who were discharged on anti-platelet agents. Methods: All the patients diagnosed with acute variceal bleeding based on gastroscopy along with acute coronary syndrome based on troponin leak with or without EKG changes, presented at The Aga Khan University Hospital, from February 2002 to February 2017 were included in the study. The medical records were reviewed to evaluate the survival outcome for 1 year. Results: Out of 39 files that were coded (ICD-9) with acute variceal bleeding and acute coronary syndrome, only data of 27 patients could be retrieved, out of them, 3 patients had no active bleeding at the time of acute coronary syndrome and 1 patient had ulcer bleed so excluded from study. So only 23 patients were included in the study. The mean age of patient 59.22 ± 11 years, 17 (74 %) of the patients were males. 10 (44 %) patients had child pugh C liver disease, followed by 8 (35 %) with child pugh B liver disease. Overall 7 (30%) had also underlying hepatocellular carcinoma. 12(52 %) patient had underlying ischemic heart disease. Out of 23, 7 (30 %) patients died during same admission, and out of 7 patients only one patient was on dual antiplatelet agents. Out of remaining 16 (70 %) patients, 4 (18 %) patients lost to follow up after discharge. Only 12 patients followed for 1 year survival and out of them only 3 patients were started on single antiplatelet agents (2 patients discharged on asprin and one patient on clopidogrel). 9/12 patients survived over 1 year and those patients with antiplatelet agent didn't developed re-bleeding. Still results are pre-liminary, final result may have little change. Conclusion: Survival outcome in patients with variceal bleeding with acute coronary syndrome is not good, and fear of re-bleed stops to offer antiplatelet agents in this setting, which is other wise, standard treatment for acute coronary syndrome. Comparing risks versus benefit, single antiplatelet agent looks relatively safer option, which can be offered cautiously in such dilemmas, after achieving hemostasis. For validation, large scale prospective studies should be considered.