Aspirin Use in the Setting of Acute Myocardial Infarction and Peptic Ulcer Bleeding Does Not Increase the Rebleeding Rate

Purpose: To determine if the use of aspirin or other anti-platelet agents is associated with adverse outcomes in patients with a bleeding peptic ulcer in the setting of acute myocardial infarction. Methods: Patients with a bleeding peptic ulcer and a concurrent acute myocardial infarction were evaluated from 2 tertiary care centers between 1999 and 2007. The pattern of aspirin (ASA) use was determined. Peptic ulcer rebleeding rates and cardiac outcomes were assessed. Results: 102 patients were evaluated retrospectively. Seventy nine patients (78%) received ASA and 46 patients (45%) received clopidogrel during an acute myocardial infarction. 34 patients (33%) were continued on ASA therapy after peptic ulcer bleeding whereas the remaining 68 patients (67%) had ASA held temporarily or discontinued during hospitalization. Patients who had ASA continued were more likely to have had a STEMI, IIb/IIIa inhibitor use, percutaneous coronary intervention and/or CABG (P < 0.05). There was no difference in the rebleeding rate from ulcers with low risk stigmata between patients who continued ASA compared to those who had ASA held or discontinued (4.0% vs 7.5%). Among patients with high risk stigmata, there was also no difference in the rebleeding rate (23% vs 29%). When ASA was continued, there was no increase in the rebleeding rate when clopidogrel was used or not (7% vs 11%). Mortality tended to be lower in patients who had ASA continued compared to those who had ASA held or discontinued (9% vs 16%). Conclusion: Aspirin does not appear to increase the rate rebleeding in patients presenting with peptic ulcer bleeding in the setting of an acute myocardial infarction.