Hurlen Mette, Eikvar Lars, Seljeflot Ingebjørg, Arnesen Harald
Ullevål University Hospital, Norway.
Thromb Res. 2006;118(4):433-8. doi: 10.1016/j.thromres.2005.07.023. Epub 2005 Aug 31.
Warfarin, aspirin, and the combination of these, have all proven to be efficacious in preventing future events after myocardial infarction. The accompanying bleeding tendency is a concern. The aim of the present study was to compare the occurrence of occult bleeding and iron deficiency during these treatment modalities.
The 267 patients who had survived a myocardial infarction were randomly assigned in the Warfarin Aspirin Reinfarction Study to treatment with aspirin 160 mg/day, or warfarin (INR 2.8-4.2), or aspirin 75 mg/day plus warfarin (INR 2.0-2.5). The patients were screened for the occurrence of occult bleeding in faeces and urine after 3 months. Haemoglobin and iron metabolism parameters were measured at baseline, after 3 months, and at the end of the 4 years follow-up.
The number of occult bleeding in faeces was 19 (7.1%) and in urine 29 (10.9%). There were no intergroup differences (p=0.45 and 0.39, respectively). In the occult bleeders, a second test showed 3 (1.1%) positive samples in faeces and 9 (3.4%) in urine. Further investigation revealed 2 cases of malignant disease. Haemoglobin and iron status variables were all within normal limits after 3 months and after 4 years in all treatment groups.
Long-term treatment with aspirin, warfarin, or both, in the present doses and levels of anticoagulation did not lead to anemia or iron deficiency. The occurrence of occult bleeding in faeces and urine was a temporary phenomenon in most patients. Only macroscopic bleedings during these treatment modalities were of clinical importance, and screening for occult bleeding was of limit value.
华法林、阿司匹林以及二者联用，均已证实对预防心肌梗死后的远期事件有效。但随之而来的出血倾向令人担忧。本研究旨在比较这些治疗方式下隐匿性出血和缺铁的发生率。
在华法林阿司匹林再梗死研究中，267例心肌梗死存活患者被随机分配接受以下治疗：每日160毫克阿司匹林，或华法林（国际标准化比值2.8 - 4.2），或每日75毫克阿司匹林加华法林（国际标准化比值2.0 - 2.5）。3个月后对患者进行粪便和尿液隐匿性出血筛查。在基线、3个月后以及4年随访结束时测量血红蛋白和铁代谢参数。
粪便隐匿性出血患者有19例（7.1%），尿液隐匿性出血患者有29例（10.9%）。组间无差异（分别为p = 0.45和0.39）。在隐匿性出血患者中，再次检测显示粪便中有3例（1.1%）阳性样本，尿液中有9例（3.4%）阳性样本。进一步检查发现2例恶性疾病。所有治疗组在3个月和4年后血红蛋白和铁状态变量均在正常范围内。
以当前剂量和抗凝水平长期使用阿司匹林、华法林或二者联用，不会导致贫血或缺铁。粪便和尿液中隐匿性出血在大多数患者中是一种暂时现象。在这些治疗方式下，只有肉眼可见的出血具有临床意义，而隐匿性出血筛查价值有限。
