Management of Patient with Simultaneous Overt Gastrointestinal Bleeding and Myocardial Infarction with ST-Segment Elevation – Priority Endoscopy
Received 14 January 2021
Accepted for publication 15 March 2021
Published 31 March 2021 Volume 2021:17 Pages 123—133
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Konstantinos Tziomalos
Jakub Nozewski,1 Grzegorz Grzesk,2 Maria Klopocka,3 Michal Wicinski,4 Klara Nicpon-Nozewska,5 Jakub Konieczny,6 Adam Wlodarczyk7
1Faculty of Health Sciences, Emergency Department, Nicolaus Copernicus University, Bydgoszcz, Poland; 2Faculty of Health Sciences, Department of Cardiology and Clinical Pharmacology, Nicolaus Copernicus University, Bydgoszcz, Poland; 3Faculty of Health Science, Department of Gastroenterology, Nicolaus Copernicus University, Bydgoszcz, Poland; 4Faculty of Medicine, Department of Pharmacology and Therapy, Nicolaus Copernicus University, Bydgoszcz, Poland; 5Faculty of Health Sciences, Department and Clinic of Geriatrics, Nicolaus Copernicus University, Bydgoszcz, Poland; 6Clinic of Emergency, Biziel’s Hospital, Bydgoszcz, Poland; 7Faculty of Medicine, Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland
Correspondence: Jakub Nozewski
Department of Emergency Medicine, Faculty of Health Science, Nicolaus Copernicus University in Toruń, Collegium Medicum, Jagiellońska 13-15, Bydgoszcz, 85-067, Poland
Tel +48 667109009
Email [email protected]
Background: The current ERC guidelines are the source of many positive changes, reduction of mortality, length of hospitalization and improvement of prognosis of STEMI patients. However, there is a small group of patients whose slight modification in guidelines would further reduce in-hospital mortality and hospitalization costs. These are patients with concomitant STEMI infarction and gastrointestinal bleeding.
Methods: Two separate methods of treatment were compared in patients with concomitant gastrointestinal bleeding and ST-segment elevation myocardial infarction. The first – traditional approach, in the line with the ESC guidelines, the second innovative, with priority for endoscopy.
Results: Despite the innovative approach, the patient with endoscopy before PCI was discharged without complication. A patient who has undergone coronary intervention and who has been started on typical antiplatelet therapy prior to gastroenterological diagnosis has died due to massive bleeding.
Conclusion: For ethical reasons and in connection with the cardiological guidelines of the management of ACS, a study of patients with ASC a high risk of intestinal bleeding, in which endoscopy will have priority, and only later PCI, will probably never be performed. Although, as the described case shows, despite exceeding the 90 minutes time to implement PCI (< 120 minutes) in logistic terms such behavior is completely feasible.
Keywords: upper gastrointestinal bleeding, acute coronary syndrome, antiplatelet and anticoagulant therapy, hemorrhage shock, proton pump inhibitors, endoscopy
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