Gastrointestinal Bleeding in Cardiac Patients

Epidemiology and Evolving Clinical Paradigms

Neena S. Abraham

Disclosures

Curr Opin Gastroenterol. 2014;30(6):609-614. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Cardiac patients are a fast emerging population vulnerable to gastrointestinal bleeding (GIB) due to their use of antithrombotic medications. This review will quantify the GIB risk of cardiac patients prescribed antithrombotic medications, summarize risk-management strategies and highlight knowledge gaps.

Recent findings As the American population ages, it is anticipated that there will be an increased incidence of upper and lower GIB related to age-specific disease, higher burden of comorbidity and increased use of anticoagulants, antiplatelets and aspirin to treat cardiac disease. New evidence has highlighted the significant and clinically relevant GIB risk. The increased use of aggressive antiplatelet and anticoagulant therapies will alter our current understanding of the epidemiology of GIB.

Summary The magnitude of gastrointestinal risk in this vulnerable patient population is still relatively unexplored due to a paucity of literature. This review will highlight changing GIB trends and explore current knowledge regarding GIB risk in cardiac patients. An emphasis on a multidisciplinary approach to the care of these patients will be supported, which involves active patient participation and collaboration between cardiologists and gastroenterologists. Finally, risk-minimization strategies will be suggested and knowledge gaps will be identified.

Introduction

The American population is growing older and it is estimated by 2030 there will be over 60 million adults 65 years and older in the United States (http://www.aoa.gov/AoARoot/Aging_Statistics/Census_Population/census2010/Index.aspx). This phenomenon will be associated with an increase in age-related comorbidities, including ischemic heart disease, hepatic, renal and malignant disease and diverticulosis.[1–4] This review evaluates epidemiologic implications of a new emerging population at risk of gastrointestinal bleeding (GIB) – the aging cardiac population. Current risk-minimization strategies will be reviewed and knowledge gaps will be identified to focus attention on future research needs.

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