Balancing cardiovascular risk and GI Risk

What is the Bleeding Risk with Cardiovascular Disease?

What is the bleeding risk with patients with cardiovascular disease? When patients end up in the cath lab cardiologists have to make a choice between cardiovascular risk and gasto-intestinal (GI) risk.  This post does talk about more so patients who have to go in the cath lab (angiogram) and get a stent.Cardiologists are  challenged with ischemic risk (lack of oxygen) vs bleeding burden to their patients having to balance optimal medical therapy such as anticoagulants or antiplatelets (asprin, plavix, warfarin etc).

Coming from a cardiovascular perspective they look at a few things.
1. Prior history of bleeding such as ulcers.

2. Older age

3. What other medications are being taken. Anticoagulants, steroids, NSAIDS including Asprin.

4. Potential drug interactions.

When patients are presented in the cath lab. Cardiologists will determine how concerned are they about the stent. Is it at a critical point. Are they concerned about stent thrombosis (blood clot inside blood vessel)? If they are concerned about GI bleeding they will probably introduce a drug PPI (Proton-pump Inhibitors) which reduces gastric acid production. Cardiologists in the cath lab should implement a good scoring system to determine cardiovascular (CV) and GI risk to determine to good course of action. The fact is that it is more frequently easy to fix GI bleeding with possible drugs or treatment vs CV risk which is much harder to fix.

If patients are taking these drugs longer term it is benefiting your cardiovascular risk but also putting your GI system at risk. It is important to look at your GI risk because it can be fixed when caught early but stopping your drugs early after an intervention is not advisable. Always talk to your healthcare team about your medications.

To your heart health success,

Diamond Fernandes

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