Research progress of coronary heart disease with gastrointestinal bleeding_West China Medical Journal

Authors：

YAN Hailin ¹ , YANG Jinlin ¹ ,  MA Hongsheng ²

1. Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Day Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

MA Hongsheng, Email: mahongsheng63@163.com

Keywords：

Coronary heart disease; Gastrointestinal bleeding; Antithrombotic; Antiplatelet; Anticoagulation

DOI：

10.7507/1002-0179.201912039

Video：

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Abstract Full text Figures/Tables Video References Cited by

Coronary heart disease with gastrointestinal bleeding is common in clinical practice. The disease is dangerous and has a high mortality rate. This article will review the risk factors for coronary heart disease with gastrointestinal bleeding (including Helicobacter pylori infection, long-term use of antiplatelet drugs and combined anticoagulation drugs), blood transfusion strategies (including hemoglobin transfusion thresholds and platelet transfusion strategies), and the management of antithrombotic drugs after bleeding (including the management of antiplatelet drugs and the management of anticoagulation combined with antiplatelet drugs). The purpose is to provide a theoretical basis for the diagnosis and treatment of coronary heart disease with gastrointestinal bleeding.

Citation： YAN Hailin, YANG Jinlin, MA Hongsheng. Research progress of coronary heart disease with gastrointestinal bleeding. West China Medical Journal, 2020, 35(6): 745-749. doi: 10.7507/1002-0179.201912039 Copy

1.	Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol, 2017, 70(1): 1-25.
2.	胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告 2018》概要. 中国循环杂志, 2019, 34(3): 209-220.
3.	Di Minno A, Spadarella G, Prisco D, et al. Antithrombotic drugs, patient characteristics, and gastrointestinal bleeding: clinical translation and areas of research. Blood Rev, 2015, 29(5): 335-343.
4.	Kikkert WJ, Delewi R, Ouweneel DM, et al. Prognostic value of access site and nonaccess site bleeding after percutaneous coronary intervention: a cohort study in ST-segment elevation myocardial infarction and comprehensive meta-analysis. JACC Cardiovasc Interv, 2014, 7(6): 622-630.
5.	Rahmani Y, Mohammadi S, Karim H, et al. Association of Helicobacter pylori and coronary heart disease in Iran: a meta-analysis. Med J Islam Repub Iran, 2018, 32: 73.
6.	Sun J, Rangan P, Bhat SS, et al. A meta-analysis of the association between helicobacter pylori infection and risk of coronary heart disease from published prospective studies. Helicobacter, 2016, 21(1): 11-23.
7.	Chmiela M, Gajewski A, Rudnicka K. Helicobacter pylori vs coronary heart disease - searching for connections. World J Cardiol, 2015, 7(4): 187-203.
8.	Stefler D, Bhopal R, Fischbacher CM. Might infection explain the higher risk of coronary heart disease in South Asians? Systematic review comparing prevalence rates with white populations in developed countries. Public Health, 2012, 126(5): 397-409.
9.	Manolakis A, Kapsoritakis AN, Potamianos SP. A review of the postulated mechanisms concerning the association of Helicobacter pylori with ischemic heart disease. Helicobacter, 2007, 12(4): 287-297.
10.	Vizzardi E, Bonadei I, Piovanelli B, et al. Helicobacter pylori and ischemic heart disease. Panminerva Med, 2011, 53(3): 193-202.
11.	Fabijanic D, Banic M, Kardum D, et al. Gastroduodenal lesions in coronary artery disease patients. Frequency, endoscopic characteristics and risk factors. Saudi Med J, 2007, 28(7): 1137-1139.
12.	Banić M, Fabijanić D, Kardum D, et al. Gastroduodenal mucosal lesions and coronary atherosclerosis severity in patients with coronary artery disease. Lijec Vjesn, 2008, 130(9/10): 228-233.
13.	Tan HJ, Goh KL. Extragastrointestinal manifestations of Helicobacter pylori infection: facts or myth? A critical review. J Dig Dis, 2012, 13(7): 342-349.
14.	Franceschi F, Tortora A, Gasbarrini G, et al. Helicobacter pylori and extragastric diseases. Helicobacter, 2014, 19(Suppl 1): 52-58.
15.	Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Thorac Cardiovasc Surg, 2016, 152(5): 1243-1275.
16.	Hallas J, Dall M, Andries A, et al. Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population based case-control study. BMJ, 2006, 333(7571): 726.
17.	Yeomans ND, Lanas AI, Talley NJ, et al. Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin. Aliment Pharmacol Ther, 2005, 22(9): 795-801.
18.	Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med, 2001, 345(7): 494-502.
19.	Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet, 2004, 364(9431): 331-337.
20.	Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med, 2006, 354(16): 1706-1717.
21.	Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 2009, 361(11): 1045-1057.
22.	Misumida N, Aoi S, Kim SM, et al. Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: Systematic review and meta-analysis. Cardiovasc Revasc Med, 2018, 19(6): 689-694.
23.	Zoni-Berisso M, Lercari F, Carazza T, et al. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol, 2014, 6: 213-220.
24.	Vandiver JW, Diane Beavers K. Combining oral anticoagulation and antiplatelet therapies: appropriate patient selection. J Thromb Thrombolysis, 2018, 45(3): 423-431.
25.	Lamberts M, Gislason GH, Lip GY, et al. Antiplatelet therapy for stable coronary artery disease in atrial fibrillation patients taking an oral anticoagulant: a nationwide cohort study. Circulation, 2014, 129(15): 1577-1585.
26.	Dentali F, Douketis JD, Lim W, et al. Combined aspirin-oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardiovascular disease: a meta-analysis of randomized trials. Arch Intern Med, 2007, 167(2): 117-124.
27.	Sørensen R, Hansen ML, Abildstrom SZ, et al. Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data. Lancet, 2009, 374(9706): 1967-1974.
28.	Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet, 2013, 381(9872): 1107-1115.
29.	Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation, 2011, 123(21): 2363-2372.
30.	Guedeney P, Sorrentino S, Claessen B, et al. The link between anemia and adverse outcomes in patients with acute coronary syndrome. Expert Rev Cardiovasc Ther, 2019, 17(3): 151-159.
31.	Kunadian V, Mehran R, Lincoff AM, et al. Effect of anemia on frequency of short- and long-term clinical events in acute coronary syndromes (from the acute catheterization and urgent intervention triage strategy trial). Am J Cardiol, 2014, 114(12): 1823-1829.
32.	Salisbury AC, Amin AP, Reid KJ, et al. Hospital-acquired anemia and in-hospital mortality in patients with acute myocardial infarction. Am Heart J, 2011, 162(2): 300-309.
33.	Garfinkle M, Lawler PR, Filion KB, et al. Red blood cell transfusion and mortality among patients hospitalized for acute coronary syndromes: a systematic review. Int J Cardiol, 2013, 164(2): 151-157.
34.	Odutayo A, Desborough MJ, Trivella M, et al. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol, 2017, 2(5): 354-360.
35.	Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy, 2015, 47(10): a1-a46.
36.	Sung JJ, Chiu PW, Chan FKL, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut, 2018, 67(10): 1757-1768.
37.	Zakko L, Rustagi T, Douglas M, et al. Tu1361 platelet transfusion for acute GI bleeding in patients taking antiplatelet agents: is there benefit or harm?. Gastroenterology, 2016, 150(4): S883-S884.
38.	Zakko L, Rustagi T, Douglas M, et al. No benefit from platelet transfusion for gastrointestinal bleeding in patients taking antiplatelet agents. Clin Gastroenterol Hepatol, 2017, 15(1): 46-52.
39.	Victor N, Umakanthan J, Gandhi A, et al. Role of platelet transfusion in gastrointestinal bleeding in patients on anti-platelet therapy. (2016-01-16)[2019-12-05]. https://www.researchgate.net/publication/290606232.
40.	Biondi-Zoccai GG, Lotrionte M, Agostoni P, et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J, 2006, 27(22): 2667-2674.
41.	Burger W, Chemnitius JM, Kneissl GD, et al. Low-dose aspirin for secondary cardiovascular prevention - cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation - review and meta-analysis. J Intern Med, 2005, 257(5): 399-414.
42.	Sung JJ, Lau JY, Ching JY, et al. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med, 2010, 152(1): 1-9.
43.	Derogar M, Sandblom G, Lundell L, et al. Discontinuation of low-dose aspirin therapy after peptic ulcer bleeding increases risk of death and acute cardiovascular events. Clin Gastroenterol Hepatol, 2013, 11(1): 38-42.
44.	Halvorsen S, Storey RF, Rocca B, et al. Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation: expert consensus paper of the European Society of Cardiology Working Group on thrombosis. Eur Heart J, 2017, 38(19): 1455-1462.
45.	Eisenberg MJ, Richard PR, Libersan D, et al. Safety of short-term discontinuation of antiplatelet therapy in patients with drug-eluting stents. Circulation, 2009, 119(12): 1634-1642.
46.	van Werkum JW, Heestermans AA, Zomer AC, et al. Predictors of coronary stent thrombosis: the dutch stent thrombosis registry. J Am Coll Cardiol, 2009, 53(16): 1399-1409.
47.	Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA, 2005, 293(17): 2126-2130.
48.	Veitch AM, Baglin TP, Gershlick AH, et al. Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut, 2008, 57(9): 1322-1329.
49.	Feres F, Costa RA, Abizaid A, et al. Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA, 2013, 310(23): 2510-2522.
50.	Navarese EP, Andreotti F, Kołodziejczak M, et al. Comparative efficacy and safety of anticoagulant strategies for acute coronary syndromes. Comprehensive network meta-analysis of 42 randomised trials involving 117,353 patients. Thromb Haemost, 2015, 114(5): 933-944.
51.	Fiedler KA, Maeng M, Mehilli J, et al. Duration of triple therapy in patients requiring oral anticoagulation after drug-eluting stent implantation: the ISAR-TRIPLE trial. J Am Coll Cardiol, 2015, 65(16): 1619-1629.

1. Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol, 2017, 70(1): 1-25.
2. 胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告 2018》概要. 中国循环杂志, 2019, 34(3): 209-220.
3. Di Minno A, Spadarella G, Prisco D, et al. Antithrombotic drugs, patient characteristics, and gastrointestinal bleeding: clinical translation and areas of research. Blood Rev, 2015, 29(5): 335-343.
4. Kikkert WJ, Delewi R, Ouweneel DM, et al. Prognostic value of access site and nonaccess site bleeding after percutaneous coronary intervention: a cohort study in ST-segment elevation myocardial infarction and comprehensive meta-analysis. JACC Cardiovasc Interv, 2014, 7(6): 622-630.
5. Rahmani Y, Mohammadi S, Karim H, et al. Association of Helicobacter pylori and coronary heart disease in Iran: a meta-analysis. Med J Islam Repub Iran, 2018, 32: 73.
6. Sun J, Rangan P, Bhat SS, et al. A meta-analysis of the association between helicobacter pylori infection and risk of coronary heart disease from published prospective studies. Helicobacter, 2016, 21(1): 11-23.
7. Chmiela M, Gajewski A, Rudnicka K. Helicobacter pylori vs coronary heart disease - searching for connections. World J Cardiol, 2015, 7(4): 187-203.
8. Stefler D, Bhopal R, Fischbacher CM. Might infection explain the higher risk of coronary heart disease in South Asians? Systematic review comparing prevalence rates with white populations in developed countries. Public Health, 2012, 126(5): 397-409.
9. Manolakis A, Kapsoritakis AN, Potamianos SP. A review of the postulated mechanisms concerning the association of Helicobacter pylori with ischemic heart disease. Helicobacter, 2007, 12(4): 287-297.
10. Vizzardi E, Bonadei I, Piovanelli B, et al. Helicobacter pylori and ischemic heart disease. Panminerva Med, 2011, 53(3): 193-202.
11. Fabijanic D, Banic M, Kardum D, et al. Gastroduodenal lesions in coronary artery disease patients. Frequency, endoscopic characteristics and risk factors. Saudi Med J, 2007, 28(7): 1137-1139.
12. Banić M, Fabijanić D, Kardum D, et al. Gastroduodenal mucosal lesions and coronary atherosclerosis severity in patients with coronary artery disease. Lijec Vjesn, 2008, 130(9/10): 228-233.
13. Tan HJ, Goh KL. Extragastrointestinal manifestations of Helicobacter pylori infection: facts or myth? A critical review. J Dig Dis, 2012, 13(7): 342-349.
14. Franceschi F, Tortora A, Gasbarrini G, et al. Helicobacter pylori and extragastric diseases. Helicobacter, 2014, 19(Suppl 1): 52-58.
15. Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Thorac Cardiovasc Surg, 2016, 152(5): 1243-1275.
16. Hallas J, Dall M, Andries A, et al. Use of single and combined antithrombotic therapy and risk of serious upper gastrointestinal bleeding: population based case-control study. BMJ, 2006, 333(7571): 726.
17. Yeomans ND, Lanas AI, Talley NJ, et al. Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin. Aliment Pharmacol Ther, 2005, 22(9): 795-801.
18. Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med, 2001, 345(7): 494-502.
19. Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet, 2004, 364(9431): 331-337.
20. Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med, 2006, 354(16): 1706-1717.
21. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 2009, 361(11): 1045-1057.
22. Misumida N, Aoi S, Kim SM, et al. Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: Systematic review and meta-analysis. Cardiovasc Revasc Med, 2018, 19(6): 689-694.
23. Zoni-Berisso M, Lercari F, Carazza T, et al. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol, 2014, 6: 213-220.
24. Vandiver JW, Diane Beavers K. Combining oral anticoagulation and antiplatelet therapies: appropriate patient selection. J Thromb Thrombolysis, 2018, 45(3): 423-431.
25. Lamberts M, Gislason GH, Lip GY, et al. Antiplatelet therapy for stable coronary artery disease in atrial fibrillation patients taking an oral anticoagulant: a nationwide cohort study. Circulation, 2014, 129(15): 1577-1585.
26. Dentali F, Douketis JD, Lim W, et al. Combined aspirin-oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardiovascular disease: a meta-analysis of randomized trials. Arch Intern Med, 2007, 167(2): 117-124.
27. Sørensen R, Hansen ML, Abildstrom SZ, et al. Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data. Lancet, 2009, 374(9706): 1967-1974.
28. Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet, 2013, 381(9872): 1107-1115.
29. Eikelboom JW, Wallentin L, Connolly SJ, et al. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation, 2011, 123(21): 2363-2372.
30. Guedeney P, Sorrentino S, Claessen B, et al. The link between anemia and adverse outcomes in patients with acute coronary syndrome. Expert Rev Cardiovasc Ther, 2019, 17(3): 151-159.
31. Kunadian V, Mehran R, Lincoff AM, et al. Effect of anemia on frequency of short- and long-term clinical events in acute coronary syndromes (from the acute catheterization and urgent intervention triage strategy trial). Am J Cardiol, 2014, 114(12): 1823-1829.
32. Salisbury AC, Amin AP, Reid KJ, et al. Hospital-acquired anemia and in-hospital mortality in patients with acute myocardial infarction. Am Heart J, 2011, 162(2): 300-309.
33. Garfinkle M, Lawler PR, Filion KB, et al. Red blood cell transfusion and mortality among patients hospitalized for acute coronary syndromes: a systematic review. Int J Cardiol, 2013, 164(2): 151-157.
34. Odutayo A, Desborough MJ, Trivella M, et al. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol, 2017, 2(5): 354-360.
35. Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy, 2015, 47(10): a1-a46.
36. Sung JJ, Chiu PW, Chan FKL, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut, 2018, 67(10): 1757-1768.
37. Zakko L, Rustagi T, Douglas M, et al. Tu1361 platelet transfusion for acute GI bleeding in patients taking antiplatelet agents: is there benefit or harm?. Gastroenterology, 2016, 150(4): S883-S884.
38. Zakko L, Rustagi T, Douglas M, et al. No benefit from platelet transfusion for gastrointestinal bleeding in patients taking antiplatelet agents. Clin Gastroenterol Hepatol, 2017, 15(1): 46-52.
39. Victor N, Umakanthan J, Gandhi A, et al. Role of platelet transfusion in gastrointestinal bleeding in patients on anti-platelet therapy. (2016-01-16)[2019-12-05]. https://www.researchgate.net/publication/290606232.
40. Biondi-Zoccai GG, Lotrionte M, Agostoni P, et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J, 2006, 27(22): 2667-2674.
41. Burger W, Chemnitius JM, Kneissl GD, et al. Low-dose aspirin for secondary cardiovascular prevention - cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation - review and meta-analysis. J Intern Med, 2005, 257(5): 399-414.
42. Sung JJ, Lau JY, Ching JY, et al. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med, 2010, 152(1): 1-9.
43. Derogar M, Sandblom G, Lundell L, et al. Discontinuation of low-dose aspirin therapy after peptic ulcer bleeding increases risk of death and acute cardiovascular events. Clin Gastroenterol Hepatol, 2013, 11(1): 38-42.
44. Halvorsen S, Storey RF, Rocca B, et al. Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation: expert consensus paper of the European Society of Cardiology Working Group on thrombosis. Eur Heart J, 2017, 38(19): 1455-1462.
45. Eisenberg MJ, Richard PR, Libersan D, et al. Safety of short-term discontinuation of antiplatelet therapy in patients with drug-eluting stents. Circulation, 2009, 119(12): 1634-1642.
46. van Werkum JW, Heestermans AA, Zomer AC, et al. Predictors of coronary stent thrombosis: the dutch stent thrombosis registry. J Am Coll Cardiol, 2009, 53(16): 1399-1409.
47. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA, 2005, 293(17): 2126-2130.
48. Veitch AM, Baglin TP, Gershlick AH, et al. Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut, 2008, 57(9): 1322-1329.
49. Feres F, Costa RA, Abizaid A, et al. Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA, 2013, 310(23): 2510-2522.
50. Navarese EP, Andreotti F, Kołodziejczak M, et al. Comparative efficacy and safety of anticoagulant strategies for acute coronary syndromes. Comprehensive network meta-analysis of 42 randomised trials involving 117,353 patients. Thromb Haemost, 2015, 114(5): 933-944.
51. Fiedler KA, Maeng M, Mehilli J, et al. Duration of triple therapy in patients requiring oral anticoagulation after drug-eluting stent implantation: the ISAR-TRIPLE trial. J Am Coll Cardiol, 2015, 65(16): 1619-1629.

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Research progress of coronary heart disease with gastrointestinal bleeding

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