UPPER GASTROINTESTINAL BLEEDING IN THE PRESENCE OR ABSENCE OF PORTAL HYPERTENSION AND/OR NON-VARICEAL LESIONS

Introduction: Dual antiplatelet therapy (DAPT) decreases major adverse cardiovascular events after a percutaneous coronary intervention (PCI).New and potentially more effective antiplatelet agents such as ticagrelor or prasugrel combined with aspirin are being prescribed preferentially to younger and healthier patients based on the potential higher risk of gastrointestinal (GI) bleeding.However, few data are available concerning the risk and type of GI bleeding asociated with these new compounds when compared to classical DAPT with clopidogrel.Aims:To determine the risk and type of major and minor GI events in patients with DAPT.To analyze PPI therapy regimens during and after DAPT withdrawal.Methods: Retrospective observational cohort study of patients who started DAPT after a PCI from January 2015 to December 2016.The follow-up period was censored either after 15 months of iniciation of DAPT, when a major GI event occurred or when DAPT was discontinued.Development of anemia during the follow-up was considered a minor GI event.Statistical analices were performedusing SPSS version 22.0.Results: 1182 patients were included (mean age 66.6±12.6 years; 77.4% males); 53.3% (630/1182), 38.2% (452/1182), and 8.5% (100/1182) of the patients were on DAPT with either clopidogrel, ticagrelor or prasugrel, respectivelly.There were statistically significant differences in baseline characteristics between groups, indicating that younger and healthier people received new antiplatelet agents (Table 1).Most patients (1104/1182; 93.4%) received PPI therapy during DAPT and after the nonaspirin agent was withdrawn (949/1104); 86%.Forty-three patients (3.6% (43/1182)) developed a major GI bleeding and 21.7% (256/1182) developed anemia.Lower GI bleeding was more frequent than upper GI bleeding (72.1% (31/43) vs 25.6% (11/43)) and 2.3% (1/43) had obscure GI bleeding.Patients who received DAPT based on clopidogrel had significant higher occurrence of anemia (27.8% vs 14.7%, p<0.001), iron deficiency (21.1% vs 13.4%, p=0.001), ischemic vascular events (13.5% vs 3.4%, p=0.036) and death (3.5 vs 1.3%, p=0.014) compared with those on DAPT with new antiplatelets.However, after adjusting for main confounding factors, including gender, age, comorbilities, anticoagulant therapy and GI risk, there were no differences between groups (clopidogrel vs new agents (overall GI events HR: 1.162 (0.881-1.532)), major GI events HR: 0.903 (0.442-1.844), minor GI events HR: 1.223 (0.905-1.653).Conclusion: DAPT is more frequently associated with lower than upper GI bleeding.Prasugrel-or ticagrelor-based DAPT was no associated with increased risk of either GI (upper or lower) bleeding when compared to clopidogrelbased therapy.The potential benefits of the new antiplatelets could be extended to all patients undergoing PCI based on GI risk factors.