Randomized Controlled Trial of Early Endoscopy for Upper Gastrointestinal Bleeding in Acute Coronary Syndrome Patients

Acute upper gastrointestinal bleeding (UGIB) in acute coronary syndrome (ACS) patients are not uncommon, particularly under dual antiplatelet therapy (DAPT). Whether early endoscopy (EE) for UGIB in these patients is efficient and safe needs to be elucidated. This multicenter randomized controlled trial randomized recent ACS patients presenting acute UGIB to non-EE and EE groups. All eligible patients received intravenous proton pump inhibitor therapy. Those in EE group underwent therapeutic endoscopy within 24 hours after bleeding. The data regarding efficacy and safety of EE were analyzed. In total, 43 patients were randomized to non-EE (21 patients) and EE (22 patients) groups. The failure rate of control hemorrhage (4.55% vs. 23.81%, p<0.001) and 3-day rebleeding rate (4.55% vs. 28.57%, p=0.033) were lower in EE than non-EE group. The mortality, minor and major complication rates were not different between two groups. Male patients were at higher risk of minor and major complications after EE with OR (95%CI) of 3.50 (1.15~10.63) and 4.25 (1.43~12.63), respectively. In multivariate analysis, EE was associated with lower needs for blood transfusion (HR 0.13, 95%CI 0.02~0.98). Among patients who discontinued DAPT during acute UGIB, a higher risk (OR 5.25, 95%CI 1.21~22.74) of coronary artery stent re-thrombosis within 6 months was noticed. EE for acute UGIB in recent ACS patients has higher rate of bleeding control, lower 3-day rebleeding rate and lower needs for blood transfusion, but more complications in male patients. (ClinicalTrial.gov Number NCT02618980, registration date 02/12/2015)