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 (defined 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 confirmation 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%); fifty 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.