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Using cardiac stents increases bleeding in patients with cirrhosis and CAD

LAS VEGAS — Patients with cirrhosis and coronary artery disease treated with coronary stents had an increased rate of gastrointestinal bleeding vs. patients with coronary artery disease treated via medical management, according to results of a retrospective study presented at ACG 2016.

Timothy Krill, MD, department of internal medicine, University of Texas Southwestern Medical Center, and colleagues reviewed medical records of 148 patients with cirrhosis and coronary artery disease (CAD), and divided them into two groups based on treatment for CAD. Sixty-eight patients underwent treatment with cardia stents and 80 served as controls and underwent medical care only.

Timothy Krill

“Since cirrhotic patients are at risk for gastrointestinal bleeding due to varices and coagulopathy, it is not clear if the benefits of treating their CAD with coronary stents outweigh the risks of gastrointestinal bleeding from the dual antiplatelet therapy required to prevent stent thrombosis,” Krill said during his presentation. “To address this issue, we assessed the rates of mortality and gastrointestinal bleeding in cirrhotic patients whose CAD was treated with cardiac stenting or with medical management.”

Dual antiplatelet therapy (DAPT) was used for at least 30 days in 99% of patients treated with stents and in only 5% of controls.

The incidence of gastrointestinal bleeding was 7.4% in patients treated with stents vs. 1.3% in controls at 30 days (P = .09); 10.3% in patients treated with stents vs. 2.5% in controls at 90 days (P = .08); 22.1% in patients treated with stents vs. 5% in controls at 1 year (P = .003); and 27.9% in patients treated with stents vs. 5% in controls at 2 years (P = .0002).

“The use of DAPT is definitely associated with substantial increased risk of GI bleeding,” Krill said.

The researchers did not observe a significant difference in mortality rate at any time between the two groups (cases vs. controls: 2.9% vs. 1.3% at 30 days; 2.9% vs. 3.8% at 90 days; and 11.8% vs. 13.8% at 1 year).

“Given no bleeding events were fatal, this increased risk of gastrointestinal bleeding may be warranted if stenting reduces cardiac mortality,” Krill concluded. – by Melinda Stevens

Reference:

Krill T, et al. Abstract #17. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 14-19, 2016; Las Vegas, NV.

Disclosure: The researchers report no relevant financial disclosures.