CASE REPORT
Diverticular bleeding complicating dual antiplatelet therapy after drug-eluting stent implantation
1
Department of Internal Medicine, Medical University of Lublin, Poland
Corresponding author
Andrzej Prystupa
Prystupa, Department of Internal Medicine, Medical University, Staszica 11, 20-081 Lublin, Poland
Prystupa, Department of Internal Medicine, Medical University, Staszica 11, 20-081 Lublin, Poland
J Pre Clin Clin Res. 2012;6(2):134-135
KEYWORDS
ABSTRACT
Acute lower gastrointestinal bleeding is defined as a bleeding situation in which blood loss has been occurring for less than 3 days resulting in haemodynamic instability, anaemia, or the need for blood transfusion. Diverticula and angiectasias are the most frequent sources of bleeding. Malignancy, inflammatory bowel disease, non-steroidal anti-inflammatory drugs, infectious colitis, ischaemia, anorectal disorders, postpolypectomy bleeding, and HIV-related problems are less frequent causes. We describe a case of a female patient aged 87 admitted to hospital because of severe intestinal bleeding. The patient was on dual antiplatelet therapy after drug-eluting stent implantation. After red blood cell and fresh frozen plasma infusion, haemostatic drug treatment as well as withdrawal of antiplatelet agents, the patient’s condition improved and became stable. Colonoscopy was then performed and residual bleeding from diverticula was revealed. Since the patient was free from symptoms and signs of recurrent bleeding, dual antiplatelet therapy was restarted without further complications.
REFERENCES (18)
1.
Barnert J, Messmann H. Management of lower gastrointestinal tract bleeding. Best Pract Res Clin Gastroenterol. 2008; 22: 295-312.
2.
Wijns W, Kolh P, Danchin N, et al. Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS); European Association for Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2010; 31(20): 2501-55.
3.
Doostzadeh J, Clark LN, Bezenek S. Recent progress in percutaneous coronary intervention: evolution of the drug-eluting stents, focus on the XIENCE V drug-eluting stent. Coron Artery Dis. 2010; 21(1): 46-56.
4.
Lemos PA, Serruys PW, Sousa JE. Drug-Eluting Stents: Costs versus clinical benefit. Circulation. 2003; 107: 3003-3007.
5.
Kim BK, Hong MK, Shin DH, et al. RESET Investigators.A New Strategy for Discontinuation of Dual Antiplatelet Therapy: The RESET Trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol. 2012; 9; 60(15): 1340-8.
6.
Bavry AA, Kumbhani DJ, Helton TJ. Late thrombosis of drug-eluting stents: a meta-analysis of randomized clinical trials. Am J Med. 2006; 119(12): 1056-1061.
7.
El Mallah W, Moliterno DJ. Early and late outcomes associated with bleeding events in the setting of dual antiplatelet therapy. Catheter Cardiovasc Interv. 2012; 80(3): 406-7.
8.
Denas G, Padayattil Jose S, Gresele P, et al. Major bleeding in patients undergoing PCI and triple or dual antithrombotic therapy: a parallelcohort study. J Thromb Thrombolysis 2013; 35(2): 178-84.
9.
Bangalore S, Kumar S, Fusaro M, et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation 2012; 125(23): 2873-91.
10.
Casado Arroyo R, Polo-Tomas M, Roncales MP, et al. Lower GI bleeding is more common than upper among patients on dual antiplatelet therapy: long-term follow-up of a cohort of patients commonly using PPI co-therapy. Heart 2012; 98(9): 718-23.
11.
Gwon HC, Hahn JY, Park KW, et al. Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: the Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting (EXCELLENT) randomized, multicenter study. Circulation. 2012; 125(3): 505-13.
12.
Valgimigli M, Campo G, Monti M, et al. Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study (PRODIGY) Investigators. Short- versus long-term duration of dualantiplatelet therapy after coronary stenting: a randomized multicenter trial. Circulation. 2012; 125(16): 2015-26.
13.
Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med. 2007; 357: 2057-2066.
14.
Meyers MA, Alonso DR, Baer JW. Pathogenesis of massively bleeding colonic diverticulosis: new observations. AJR Am J Roentgenol. 1976; 127: 901-908.
15.
Bjarnason I, Hayllar J, MacPherson AJ, Russell AS. Side effects of nonsteroidal antiinflammatory drugs on the small and large intestine in humans. Gastroenterology 1993; 104: 1832-1847.
16.
Hung CR. Protective effect of verapamil on gastric hemorrhagic ulcers in severe atherosclerotic rats. Chin J Physiol. 2007; 50: 315-325.
17.
Strate LL, Liu YL, Huang ES, Giovannucci EL, Chan AT. Use of aspirin or nonsteroidal anti-inflammatory drugs increases risk for diverticulitis and diverticular bleeding. Gastroenterology. 2011; 140(5): 1427-33.
18.
Yamada A, Sugimoto T, Kondo S, Ohta M, Watabe H, Maeda S, et al. Assessment of the risk factors for colonic diverticular hemorrhage. Dis Colon Rectum. 2008; 51: 116-120.
| eISSN: | 1898-7516 |
| ISSN: | 1898-2395 |
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