Prevalence of Chronic Myocardial Ischemia and Gastrointestinal Bleeding Risk in Patients With Chronic Kidney Disease Undergoing Dual Antiplatelet Therapy

Background Chronic kidney disease (CKD) is strongly associated with an increased risk of cardiovascular morbidity and mortality, with chronic myocardial ischemia being a frequent complication. Objective The objective of this study is to determine the prevalence of chronic myocardial ischemia and evaluate the gastrointestinal bleeding risk in CKD patients receiving dual antiplatelet therapy. Methods This cross-sectional observational study was conducted at the Dow University of Health and Sciences in Karachi between January and July 2025. A total of 180 patients with diagnosed CKD who were undergoing dual antiplatelet therapy were chosen for the study. Clinical assessment, laboratory parameters, and electrocardiographic findings were used to evaluate chronic myocardial ischemia. Gastrointestinal bleeding risk was assessed through clinical history, endoscopic evaluation (when indicated), and validated bleeding risk scores. Results Among 180 CKD patients, 74 (41.1%) demonstrated evidence of chronic myocardial ischemia on ECG and clinical evaluation. Gastrointestinal bleeding events were documented in 32 (17.8%) patients, while an additional 46 (25.6%) were classified as high risk for bleeding based on clinical and endoscopic assessment. Patients in advanced CKD stages (Stage 4 and 5, n=110) had a significantly higher prevalence of myocardial ischemia (57/110, 51.8%) and gastrointestinal bleeding risk (31/110, 28.2%) compared to those in earlier stage CKD (Stage 3, n=70; ischemia 20/70, 28.6%; bleeding risk 12/70, 17.1%) (p<0.05). Conclusion Chronic myocardial ischemia and gastrointestinal bleeding risk are both highly prevalent in CKD patients undergoing dual antiplatelet therapy. Nearly half of the patients exhibited ischemic burden, while one-fifth experienced bleeding events.