Retrospective Analysis Of Clinical Outcomes Of Acute Coronary Syndrome Patients With Severe Gastrointestinal Bleeding During Dual Antiplatelet Threapy

Background and Objective:Dual antiplatelet therapy(DAPT)is an important clinical strategy of ACS.Most patients receive antiplatelet therapy for a certain period of time after diagnosis of ACS.At presetnt,guidelines advise aspirin + P2Y12 inhibitor as standard DAPT.With the increase of patients receiving DAPT,bleeding events,especially gastrointestinal bleeding(GIB),have gotten more and more attention.However,there is still a lack of randomized controlled trial(RCT)for antiplatelet therapy in ACS patients with DAPT undergoing GIB.In order to explore antiplatelet strategies and clinical outcomes of ACS patients with severe GIB during the treatment of aspirin combined with clopidogrel,this retrospective analysis was conducted.Methods:The patients admitted to Nanfang Hospital and Guangdong General Hospital for diagnosis of ACS as well as gastrointestinal bleeding from 2009 to 2016 was included in this study.According to the inclusion and exclusion criteria,patients were selected due to diagnosis of ACS and regularly oral taking aspirin(100mg/day)combined with clopidogrel(75 mg/day),then following severe GIB(Bleeding Academic investigation committee score,BARC?3)during 1 year treatment and requiring hospitalization.Baseline data was collected and therapy strategies were confirmed,a 1-year follow-up was conducted by telephone or hospitalized electronic medical record system among screened patients of survival discharge,to observe the primary endpoint events for major adverse cardiovascular events(MACEs:all-cause death,nonfatal myocardial infarction,nonfatal ischemic cerebral stroke and coronary artery reavascularization).Safety endpoint events were BARC non-fatal bleeding events.ResultA total of 91 subjects were included in the study.In antiplatelet strategies,4 different strategies were made:A.Clopidogrel(75 mg 1/day)(n=53)B.Aspirin(100 mg 1/day)(n=5)C.Clopidogrel(75 mg 1/day)+ cilostazol(100 mg 1/day)(n?28)D.Continuation of aspirin(100 mg 1/day)+ clopidogrel(75 mg 1/day)(n =5),with a combination of proton pump inhibitors(PPIs)among all patients.Due to the small number of patients in groups B and D(n=5),only the differences between groups A and C were compared.The results showed that clopidogrel + cilotazole strategy was mainly used in the patients who had a short interval of GIB from the start of DAPT.The clopidogrel + cilotazole group could reduce the coronary artery reascularization rate(0.00%vs.15.09%,P=0.046)within 1 year compared with clopidogrel group,and there were no significant difference in other MACEs and bleeding events.In different departments,12 of 65 patients admitted to Cardiology insprcted Helicobacter Pylori(HP),and 19 of 26 patients admitted to Gastroenterology did.Patients admitted to Cardiology accepted more DAPT(clopidogrel + cilostazol,clopidogrel + aspirin)when they discharged from hospital.Only 36(39.56%)patients in all patients underwent gastroscopy.Conclusion:In the ACS patients with severe gastrointestinal bleeding during DAPT:1.Clopidogrel+cilostazol is an effective antiplate strategy.2.Patients adimitted in different departments have different antiplatelet strategies after discharge from hospital.3.There are some differences in clinical guidelines and practice of HP inspection.4.The endoscopy rate is low in all patients.