Prevalence and Outcome of Upper Gastrointestinal Bleeding Post-coronary Artery Bypass Graft
Abstract
Background: Upper gastrointestinal bleeding (UGIB), a potentially fatal occurrence, can sometimes follow coronary artery bypass
graft (CABG) surgery. However, little has been published about its prevalence, risk factors, and outcomes.
Aim: This study aimed to determine the rate, etiologies, predisposing factors, and outcomes of UGIB following CABG.
Method: The authors conducted a retrospective chart review of all UGIBs which followed CABGs performed at the University of
Alberta Hospital from January 1, 1998 to December 31, 2002.
Results: During the study period, 4,502 CABGs were performed at the UAH. Eighteen patients (0.4%) had a documented major
UGIB (dened as evidence of melena, red or coffee-grounds emesis, blood per NG tube, or a decrease of Hgb by > 20 g/l and
requiring a conrmation by endoscopy or radiological study). Two of these 18 patients (11%) had a past history of peptic ulcer
disease, and one of these patients had had previous UGIB. Three patients (17%) had been taking proton pump inhibitors (PPI)
before the UGIB occurred. At the time of UGIB, PPIs were prescribed for 16 patients (89%), and the PPIs achieved effective
hemostasis as a single agent for 10 (62.5%). Of the 18 patients, 16 (89%) underwent upper GI endoscopy. Bleeding was found to
be due to duodenal ulceration in 9 (56%), esophagitis in 4 (22%) and gastritis in 6 cases (33%); fty percent of these patients had
multiple sites of bleeding. Endoscopic therapeutic intervention was needed by 6 patients (37.5%), and successful hemostasis was
achieved for 5 of these patients (83%). One patient had a recurrence of bleeding and required surgery. One patient underwent
surgery as the primary hemostatic therapy after a diagnostic endoscopy. The overall surgical rate was 11.1% for this patient
cohort. In this cohort, three patients died, two from multi-organ failure, and the third, a surgically managed patient, had a cardiac
arrest 72 hours post-surgery. The number of complication increased as both cardiopulmonary bypass and cross clamp time
increased. There were no endoscopy-related complications.
Conclusions: UGI bleeding following CABGs is relatively infrequent, occurring at a rate of 0.4% in this study. Upper gastrointestinal
bleeding post-CABG is most frequently related to a duodenal ulcer, though 50% of the patients had multiple bleeding sites.
prolonged bypass and cross clamp time associated with more complications.
Keywords: Upper gastrointestinal bleeding, Coronary artery bypass surgery, Post-operative complications.
graft (CABG) surgery. However, little has been published about its prevalence, risk factors, and outcomes.
Aim: This study aimed to determine the rate, etiologies, predisposing factors, and outcomes of UGIB following CABG.
Method: The authors conducted a retrospective chart review of all UGIBs which followed CABGs performed at the University of
Alberta Hospital from January 1, 1998 to December 31, 2002.
Results: During the study period, 4,502 CABGs were performed at the UAH. Eighteen patients (0.4%) had a documented major
UGIB (dened as evidence of melena, red or coffee-grounds emesis, blood per NG tube, or a decrease of Hgb by > 20 g/l and
requiring a conrmation by endoscopy or radiological study). Two of these 18 patients (11%) had a past history of peptic ulcer
disease, and one of these patients had had previous UGIB. Three patients (17%) had been taking proton pump inhibitors (PPI)
before the UGIB occurred. At the time of UGIB, PPIs were prescribed for 16 patients (89%), and the PPIs achieved effective
hemostasis as a single agent for 10 (62.5%). Of the 18 patients, 16 (89%) underwent upper GI endoscopy. Bleeding was found to
be due to duodenal ulceration in 9 (56%), esophagitis in 4 (22%) and gastritis in 6 cases (33%); fty percent of these patients had
multiple sites of bleeding. Endoscopic therapeutic intervention was needed by 6 patients (37.5%), and successful hemostasis was
achieved for 5 of these patients (83%). One patient had a recurrence of bleeding and required surgery. One patient underwent
surgery as the primary hemostatic therapy after a diagnostic endoscopy. The overall surgical rate was 11.1% for this patient
cohort. In this cohort, three patients died, two from multi-organ failure, and the third, a surgically managed patient, had a cardiac
arrest 72 hours post-surgery. The number of complication increased as both cardiopulmonary bypass and cross clamp time
increased. There were no endoscopy-related complications.
Conclusions: UGI bleeding following CABGs is relatively infrequent, occurring at a rate of 0.4% in this study. Upper gastrointestinal
bleeding post-CABG is most frequently related to a duodenal ulcer, though 50% of the patients had multiple bleeding sites.
prolonged bypass and cross clamp time associated with more complications.
Keywords: Upper gastrointestinal bleeding, Coronary artery bypass surgery, Post-operative complications.
Wong, W., Modry, D., Fedorak, R., & Aljarallah, B. (2008). Prevalence and Outcome of Upper Gastrointestinal Bleeding Post-coronary Artery Bypass Graft. International Journal of Health Sciences, 2(1). Retrieved from https://ijhs.qu.edu.sa/index.php/journal/article/view/72
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