Acute GI Bleeding After Percutaneous Coronary Intervention
Acute GI Bleeding After Percutaneous Coronary Intervention
Data on bleeding distal to the duodenum post PCI are lacking. Anecdotally, the vast majority of cases are of the esophagus, stomach and duodenum. There are no specific reviews of the management of an acute lower GI bleed after PCI, although guidelines do exist for lower GI bleeding in general populations. Aspirin use increases the risk of diverticular bleeding and hence this possibility must be considered in those with lower GI bleeding. There are no data examining the safety of colonoscopy after PCI. A case–control study of 100 consecutive patients undergoing colonoscopy within 30 days of MI demonstrated no increase in major complications, although there were significantly more minor, transient cardiovascular complications such as bradycardia and hypotension. In patients with bleeding distal to the duodenum after PCI, management needs to be individualized. In our practice, colonoscopy is often temporarily postponed, particularly if bleeding is low volume and short lived.
Bleeding from the jejunum and ileum also appears to be uncommon post PCI, although it is accepted that both aspirin and thienopyridines are risk factors for what is considered obscure GI bleeding. Whether to use imaging (e.g., radiolabeled red cell scanning or computed tomography angiography) or endoscopy (e.g., capsule endoscopy or double-balloon enteroscopy) will depend upon individual patient characteristics and magnitude of bleeding, together with local availability and expertise.
Non-upper GI Bleeding
Data on bleeding distal to the duodenum post PCI are lacking. Anecdotally, the vast majority of cases are of the esophagus, stomach and duodenum. There are no specific reviews of the management of an acute lower GI bleed after PCI, although guidelines do exist for lower GI bleeding in general populations. Aspirin use increases the risk of diverticular bleeding and hence this possibility must be considered in those with lower GI bleeding. There are no data examining the safety of colonoscopy after PCI. A case–control study of 100 consecutive patients undergoing colonoscopy within 30 days of MI demonstrated no increase in major complications, although there were significantly more minor, transient cardiovascular complications such as bradycardia and hypotension. In patients with bleeding distal to the duodenum after PCI, management needs to be individualized. In our practice, colonoscopy is often temporarily postponed, particularly if bleeding is low volume and short lived.
Bleeding from the jejunum and ileum also appears to be uncommon post PCI, although it is accepted that both aspirin and thienopyridines are risk factors for what is considered obscure GI bleeding. Whether to use imaging (e.g., radiolabeled red cell scanning or computed tomography angiography) or endoscopy (e.g., capsule endoscopy or double-balloon enteroscopy) will depend upon individual patient characteristics and magnitude of bleeding, together with local availability and expertise.