[When anti-thrombosis meets bleeding] Dual antiplatelet therapy for acute coronary syndrome and prevention and treatment of bleeding complications

For patients with gastrointestinal bleeding after antithromboticism, the question often faced in treatment is: Do antithrombotic drugs be discontinued? How do I adjust antithrombotic drugs? How to choose a drug for the treatment of gastrointestinal bleeding? How to grasp the timing of gastroscopy and treatment? When and how should patients who discontinue antithrombotic therapy return to antithrombotic therapy early?

In response to these problems, the 2016 Interdisciplinary and Interventional Treatment Conference on Coronary Heart Diseases was held by a case of gastrointestinal bleeding after percutaneous coronary intervention (PCI) of acute coronary syndrome (ACS), and a dialogue between cardiology and gastroenterology experts was initiated, as detailed in the C2-C5 edition

Antiplatelet therapy is the cornerstone of

Bleeding risk of DAPT

The NCDR Cath PCI registry study showed that between 2005 and 2009, there was a downward trend in the overall incidence of bleeding, regardless of elective or emergency PCI, mainly due to a decrease in the incidence of bleeding at the puncture site, rather than a significant decrease in bleeding at the non-puncture site, but even an increase in patients with

Prevention of DAPT with bleeding

Predictors of bleeding events in PATIENTS with ACS receiving DAPT include (1) non-interventional factors: demographic and clinical features (e.

Patients with a previous history of ulcer disease or Helicobacter pylori infection are at higher risk of upper gastrointestinal bleeding, on the basis of which antiplatelet agents further increase bleeding events

The 2010 COGENT study showed that the prophylactic use of omeprazole in patients receiving DAPT significantly reduced the risk of upper gastrointestinal bleeding and did not increase cardiovascular events

Adjustment of antiplatelet therapy in patients with ACS with bleeding

Patients with ACS have bleeding, first of all, it is necessary to combine the bleeding site (puncture site, subcutaneous, retroperitoneal, gastrointestinal tract, intracranial, etc.

The 2011 ESC NSTE-ACS management guidelines recommend that small amounts of TIMI bleeding do not need to interrupt DAPT if they are not persistent; Massive bleeding is still uncontrollable with appropriate intervention and requires interruption or neutralization of antiplatelet and anticoagulant therapy; Bleeding can be completely controlled by local treatment, generally without interrupting antithrombotic therapy; The 2012 NICE guidelines for acute upper gastrointestinal bleeding recommend that endoscopy is the key to the diagnosis of the cause of upper gastrointestinal bleeding, severe upper gastrointestinal bleeding, hemodynamic instability should first correct circulatory failure and then perform endoscopy as soon as possible; All other patients with upper gastrointestinal bleeding should be completed as early as possible within 24 hours

Summary and recommendations

Antiplatelet therapy runs through the acute stage of ACS onset and even throughout life, which is the cornerstone of the prevention and treatment of ACS, but at the same time it is a double-edged sword, and there are contradictions