PMID- 18177451
OWN - NLM
STAT- MEDLINE
DCOM- 20080603
LR  - 20220419
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 103
IP  - 4
DP  - 2008 Apr
TI  - Gastrointestinal bleeding in patients receiving a combination of aspirin, 
      clopidogrel, and enoxaparin in acute coronary syndrome.
PG  - 865-71
LID - 10.1111/j.1572-0241.2007.01715.x [doi]
AB  - BACKGROUND: The combination of aspirin, clopidogrel, and enoxaparin (combination 
      therapy) is the standard treatment for acute coronary syndrome but is associated 
      with gastrointestinal bleeding. However, information in this area is scarce. AIM: 
      This retrospective study aimed to determine the incidence of upper 
      gastrointestinal bleeding in a real-life situation. The effect of proton pump 
      inhibitor (PPI) treatment was also analyzed. METHOD: From January 2002 to 
      December 2006, all patients receiving combination therapy were analyzed. The end 
      point was the occurrence of upper gastrointestinal bleeding during combination 
      therapy or within 7 days of stopping enoxaparin. RESULTS: The patient group 
      consisted of 666 patients (age 72.1 +/- 12.6 yr). Gastrointestinal bleeding 
      occurred in 18 (2.7%) patients. The overall hospital mortality was 4.1% (27 
      patients). A cardiac event was the major cause (N = 24, 3.6%). Only one patient 
      died of massive gastrointestinal bleeding (0.15%). Multiple logistic regression 
      analysis demonstrated that previous peptic ulcer, cardiogenic shock, and the lack 
      of PPI coprescription were significant risk factors for gastrointestinal 
      bleeding. The age-adjusted odds ratio (95% confidence interval) for 
      gastrointestinal bleeding was 5.07 (1.31-16.58) for previous peptic ulcer, 21.41 
      (2.56-146.68) for cardiogenic shock, and 0.068 (0.010-0.272) for the 
      coprescription with a PPI. CONCLUSION: In real life, the incidence of 
      gastrointestinal bleeding associated with the combination of aspirin, 
      clopidogrel, and enoxaparin therapy was estimated to be 2.7%. Previous peptic 
      ulcer disease or cardiogenic shock were significant independent risk factors. 
      Coprescription with a PPI can significantly reduce the risk.
FAU - Ng, Fook-Hong
AU  - Ng FH
AD  - Department of Medicine, Ruttonjee Hospital, Hong Kong, China.
FAU - Wong, Siu-Yin
AU  - Wong SY
FAU - Lam, Kwok-Fai
AU  - Lam KF
FAU - Chang, Chee-My
AU  - Chang CM
FAU - Lau, Yuk-Kong
AU  - Lau YK
FAU - Chu, Wai-Ming
AU  - Chu WM
FAU - Wong, Benjamin C Y
AU  - Wong BC
LA  - eng
PT  - Journal Article
DEP - 20080102
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
CIN - Am J Gastroenterol. 2008 Nov;103(11):2948-9. PMID: 19032481
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*adverse effects
MH  - Aspirin/*adverse effects
MH  - Clopidogrel
MH  - Drug Therapy, Combination
MH  - Enoxaparin/*adverse effects
MH  - Female
MH  - Gastrointestinal Hemorrhage/*chemically induced
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*adverse effects
MH  - Retrospective Studies
MH  - Statistics, Nonparametric
MH  - Ticlopidine/adverse effects/*analogs & derivatives
EDAT- 2008/01/08 09:00
MHDA- 2008/06/05 09:00
CRDT- 2008/01/08 09:00
PHST- 2008/01/08 09:00 [pubmed]
PHST- 2008/06/05 09:00 [medline]
PHST- 2008/01/08 09:00 [entrez]
AID - AJG1715 [pii]
AID - 10.1111/j.1572-0241.2007.01715.x [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2008 Apr;103(4):865-71. doi: 
      10.1111/j.1572-0241.2007.01715.x. Epub 2008 Jan 2.