PMID- 28488370
OWN - NLM
STAT- MEDLINE
DCOM- 20171204
LR  - 20181202
IS  - 1365-2036 (Electronic)
IS  - 0269-2813 (Linking)
VI  - 46
IP  - 2
DP  - 2017 Jul
TI  - Patients with cirrhosis who have coronary artery disease treated with cardiac 
      stents have high rates of gastrointestinal bleeding, but no increased mortality.
PG  - 183-192
LID - 10.1111/apt.14121 [doi]
AB  - BACKGROUND: Patients with coronary artery disease (CAD) treated with stents 
      require dual antiplatelet therapy (DAPT). For cirrhotics, who often have varices 
      and coagulopathy, it is not clear if the risk of gastrointestinal bleeding (GIB) 
      should preclude use of DAPT. AIM: To compare GIB and mortality rates in 
      cirrhotics with CAD treated medically or with stents. METHODS: Using 
      institutional databases, we identified patients with cirrhosis and CAD treated 
      with stents or medical therapy between January 2000-September 2015. Primary 
      outcomes were GIB and mortality. RESULTS: We identified 148 cirrhotics with CAD; 
      68 received stents (cases), 80 were treated with medical therapy (controls). 
      Cases and controls had similar demographics, comorbidities, MELD scores and 
      clinical presentation; DAPT was used in 98.5% of cases vs 5% of controls. The 
      incidence of GIB was significantly higher in cases than controls (22.1% vs 5% at 
      1 year, P=.003; 27.9% vs 5% at 2 years, P=.0002), whereas all-cause mortality was 
      similar (20.6% vs 21.3%). No patient required surgery or angiography for GIB, and 
      no known patients died due to GIB. Multivariate analysis revealed use of a proton 
      pump inhibitor (PPI) was highly protective against GIB (OR=0.26, 
      95%CI=0.08-0.79). CONCLUSIONS: CAD treatment with stents in our cirrhotics was 
      associated with a significantly increased risk of GIB, but no adverse effects on 
      survival. Although it remains unclear whether the cardiovascular benefits of 
      stents outweigh the GIB risk, our findings suggest that DAPT should not be 
      withheld from stented cirrhotics for fear of GIB. Moreover, the use of a PPI 
      should be strongly considered.
CI  - (c) 2017 John Wiley & Sons Ltd.
FAU - Krill, T
AU  - Krill T
AD  - Division of Digestive and Liver Disease, VA North Texas Healthcare System, 
      Dallas, TX, USA.
AD  - Division of Digestive and Liver Diseases, University of Texas Southwestern 
      Medical Center, Dallas, TX, USA.
FAU - Brown, G
AU  - Brown G
AD  - Division of Digestive and Liver Disease, VA North Texas Healthcare System, 
      Dallas, TX, USA.
AD  - Division of Digestive and Liver Diseases, University of Texas Southwestern 
      Medical Center, Dallas, TX, USA.
FAU - Weideman, R A
AU  - Weideman RA
AD  - Department of Pharmacy, VA North Texas Healthcare System, Dallas, TX, USA.
FAU - Cipher, D J
AU  - Cipher DJ
AD  - College of Nursing and Health Innovation, University of Texas at Arlington, 
      Arlington, TX, USA.
FAU - Spechler, S J
AU  - Spechler SJ
AD  - Division of Digestive and Liver Disease, VA North Texas Healthcare System, 
      Dallas, TX, USA.
AD  - Division of Digestive and Liver Diseases, University of Texas Southwestern 
      Medical Center, Dallas, TX, USA.
FAU - Brilakis, E
AU  - Brilakis E
AD  - Division of Cardiology, VA North Texas Healthcare System, Dallas, TX, USA.
AD  - Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, 
      TX, USA.
FAU - Feagins, L A
AU  - Feagins LA
AUID- ORCID: 0000-0001-7758-3257
AD  - Division of Digestive and Liver Disease, VA North Texas Healthcare System, 
      Dallas, TX, USA.
AD  - Division of Digestive and Liver Diseases, University of Texas Southwestern 
      Medical Center, Dallas, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20170509
PL  - England
TA  - Aliment Pharmacol Ther
JT  - Alimentary pharmacology & therapeutics
JID - 8707234
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Aliment Pharmacol Ther. 2017 Sep;46(6):639. PMID: 28805330
CIN - Aliment Pharmacol Ther. 2017 Sep;46(6):638-639. PMID: 28805332
CIN - Aliment Pharmacol Ther. 2017 Oct;46(7):709. PMID: 28880447
CIN - Aliment Pharmacol Ther. 2017 Oct;46(7):710. PMID: 28880452
MH  - Aged
MH  - Case-Control Studies
MH  - Coronary Artery Disease/*epidemiology/*surgery
MH  - Drug Therapy, Combination
MH  - Female
MH  - Gastrointestinal Hemorrhage/*etiology
MH  - Humans
MH  - Liver Cirrhosis/*epidemiology
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/administration & dosage/*adverse effects
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Retrospective Studies
MH  - *Stents
OTO - NOTNLM
OT  - aspirin
OT  - cirrhosis
OT  - gastrointestinal haemorrhage
OT  - thienopyridine
EDAT- 2017/05/11 06:00
MHDA- 2017/12/05 06:00
CRDT- 2017/05/11 06:00
PHST- 2017/02/05 00:00 [received]
PHST- 2017/02/19 00:00 [revised]
PHST- 2017/04/08 00:00 [accepted]
PHST- 2017/05/11 06:00 [pubmed]
PHST- 2017/12/05 06:00 [medline]
PHST- 2017/05/11 06:00 [entrez]
AID - 10.1111/apt.14121 [doi]
PST - ppublish
SO  - Aliment Pharmacol Ther. 2017 Jul;46(2):183-192. doi: 10.1111/apt.14121. Epub 2017 
      May 9.