Taha A S, Angerson W J, Knill-Jones R P, Blatchford O
Department of Gastroenterology, Crosshouse Hospital, Kilmarnock, Scotland, UK.
Aliment Pharmacol Ther. 2006 Feb 15;23(4):489-95. doi: 10.1111/j.1365-2036.2006.02784.x.
Little is known about the site and nature of bleeding lesions related to low-dose aspirin and other antithrombotic agents.
To describe the mucosal abnormalities in patients presenting with upper gastrointestinal bleeding while being treated with these drugs.
The endoscopic findings and clinical details were analysed in all patients presenting with haematemesis and/or melaena at a single centre during three calendar years. Associations between endoscopic findings and risk factors, including the intake of non-steroidal anti-inflammatory drugs, low-dose aspirin (75 mg daily) and other antithrombotic drugs including warfarin, clopidogrel, and dipyridamole, were assessed by logistic regression analysis.
In 674 upper gastrointestinal bleeders, we found that the odds ratio for the presence of erosive oesophagitis in aspirin users was 2 (95% CI, 1-3; P = 0.03) and 3 (2-5; P = 0.0003) in patients taking other antithrombotic agents. In 41 patients with oesophagitis and taking these drugs, 36 (88%) had cardiovascular disease and only 4 (10%) had peptic symptoms.
Erosive oesophagitis is common in patients with upper gastrointestinal bleeding taking low-dose aspirin or antithrombotic agents, and could potentially be confused with the coexisting heart disease.
关于与低剂量阿司匹林及其他抗血栓药物相关的出血性病变的部位和性质，人们了解甚少。
描述在接受这些药物治疗时出现上消化道出血的患者的黏膜异常情况。
对三个日历年内在单一中心出现呕血和/或黑便的所有患者的内镜检查结果和临床细节进行分析。通过逻辑回归分析评估内镜检查结果与风险因素之间的关联，这些风险因素包括非甾体抗炎药、低剂量阿司匹林（每日75毫克）以及其他抗血栓药物，如华法林、氯吡格雷和双嘧达莫。
在674例上消化道出血患者中，我们发现服用阿司匹林的患者出现糜烂性食管炎的比值比为2（95%可信区间，1 - 3；P = 0.03），服用其他抗血栓药物的患者为3（2 - 5；P = 0.0003）。在41例患有食管炎且服用这些药物的患者中，36例（88%）患有心血管疾病，只有4例（10%）有消化症状。
糜烂性食管炎在服用低剂量阿司匹林或抗血栓药物的上消化道出血患者中很常见，并且可能与并存的心脏病相混淆。
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