Gastrointestinal complications after 3 months of dual antiplatelet therapy for drug-eluting stents as assessed by wireless capsule endoscopy.

Little is known about the frequency of symptomatic and asymptomatic gastrointestinal complications of dual antiplatelet therapy. We recruited 30 patients between 18 and 80 years who were started on aspirin and clopidogrel following percutaneous coronary intervention with drug-eluting stents. We hypothesized that the 3 months of dual antiplatelet therapy would be associated with frequent upper gastrointestinal endoscopic abnormalities. Patients were followed with weekly phone calls to inquire about the new gastrointestinal symptoms and after a minimum of 80 days, their upper gastrointestinal mucosa was visualized with PillCam ESO wireless capsule endoscopy. 18 (90%) of the 20 successful wireless capsule endoscopies revealed at least 1 type of gastrointestinal mucosal lesion. Gastric erosions (n = 14, 70%) were the most common abnormality. We believe this is the first noninvasive endoscopic study of gastrointestinal complications of dual antiplatelet therapy in patients who undergo percutaneous coronary intervention with drug-eluting stents. Future studies should expand on our observations to determine whether prophylaxis with proton pump inhibitors is warranted.

Hepatic venous pressure gradient supplements liver biopsy in the diagnosis of cirrhosis.

BACKGROUND: Liver biopsy is the gold standard for establishing cirrhosis, but may provide inadequate tissue for interpretation in some patients. GOALS: The aim of this study was to determine whether the hepatic venous pressure gradient predicts the presence of cirrhosis. STUDY: Patients with liver disease who had undergone hepatic venous pressure gradient measurements were identified. Clinical, laboratory, and hepatic venous pressure gradient data were collected and biopsies were staged for fibrosis. Univariable logistic regression was used to identify potential predictors of cirrhosis. Multivariable logistic regression was applied to determine adjusted odds ratios. RESULTS: Thirty-two patients were included. The hepatic venous pressure gradient was an independent predictor of cirrhosis. On multivariable analysis, the hepatic venous pressure gradient predicted cirrhosis, with an odds ratio of 1.46 (95% confidence interval 1.05-2.02, P=0.023). Using a cutoff of >or=6.5 mm Hg, the hepatic venous pressure gradient was 86% sensitive and 80% specific for diagnosing cirrhosis. CONCLUSIONS: The hepatic venous pressure gradient measurement predicts the presence of cirrhosis in patients with liver disease. Therefore, when the diagnosis of cirrhosis is in question, an elevated hepatic venous pressure gradient can support the diagnosis.

Impact of anticoagulation on rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage.

OBJECTIVE: Endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage achieves hemostasis in greater than 90% of patients, but up to 20% rebleed. The aim of this study was to determine the impact of anticoagulation on rebleeding in patients undergoing endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage. METHODS: Patients who underwent successful endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage between July 1, 1999, and June 30, 2004, at a large, tertiary care teaching hospital were identified. The primary outcome was rebleeding within 30 days. Secondary outcomes were transfusion requirement, length of stay, surgery, and mortality. Baseline data were analyzed using t-tests and chi(2) tests. Multivariable logistic and linear regression analyses were carried out to calculate the adjusted odds ratios for the international normalized ratio (INR) predicting the primary and secondary outcomes. The multivariable analyses controlled for: age, Charlson comorbidity index, antiplatelet agent use, postprocedure heparin use, postprocedure proton pump inhibitor use, hypotension, ulcer as the bleeding source, and active bleeding at endoscopy. RESULTS: The study included 233 patients. Forty-four percent of the patients had an INR >or=1.3. Ninety-five percent of the anticoagulated patients had an INR between 1.3 and 2.7. The rebleeding rate was 23% in the anticoagulated patients and 21% in the patients with INRs <1.3. On multivariable analyses, INR was not a predictor of rebleeding, transfusion requirement, surgery, length of stay, or mortality. CONCLUSIONS: Mild to moderate anticoagulation does not increase the risk of rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage, suggesting that endoscopic therapy is appropriate in these patients.