Division of Cardiology and Gastroenterology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
J Clin Gastroenterol. 2011 May-Jun;45(5):410-4. doi: 10.1097/MCG.0b013e3181faec3c.
The benefits of dual antiplatelet therapy are counterbalanced by the increased incidence of gastrointestinal (GI) complications. The aim of this study was to determine the frequency of GI bleeding, identify the predictors associated with the increased bleeding, and determine the short-term and long-term outcomes.
This was an observational, case-control cohort study carried out at the Albert Einstein Medical Center. It included all patients who had a drug-eluting stent implanted between May 2003 and April 2007. A total of 1852 patients were identified; of these 50 patients were readmitted for a GI bleed. A control group of 202 patients who did not have any evidence of GI bleeding were compared with the original group. All data were expressed as mean±SD. The baseline clinical characteristics between the 2 groups were compared using the t test and the Fisher exact test. Multivariate analysis was used to determine the predictors of GI bleeding.
The rate of GI bleeding was 2.7%. The mean age in the group with GI bleeding was 70.9±12.2 years, whereas in the group without GI bleeding it was 66.5±12.8 years (P<0.05). The majority of the patients presented with melena (40%). Gastritis and gastric ulcers were the most common findings seen in 49% of the patients on endoscopy. On multivariate logistic regression analysis, a history of GI bleeding was the most important independent predictor of future GI bleeding (P<0.001), whereas the use of statins was found to be protective (95% confidence interval, 0.13-0.48; P<0.001) against future GI bleeding. The 30-day mortality rate in the GI bleeding and control groups was 3.7% and 0%, respectively (P<0.01), whereas in the corresponding 1 year the mortality rate was 18.9% and 0%, respectively (P<0.001).
The rate of GI bleeding in patients on dual antiplatelet therapy is low. Earlier history of GI bleeding is the most significant multivariate predictor of future GI bleeding whereas statins seemed to be protective. Patients with GI bleeding have increased short-term and long-term mortality; thereby a history of earlier GI bleeding needs to be assessed carefully before starting dual antiplatelet therapy. This may play a vital role in the selection of therapeutic strategies in these patients.
双联抗血小板治疗的益处被胃肠道（GI）并发症发生率的增加所抵消。本研究的目的是确定 GI 出血的频率，确定与出血增加相关的预测因素，并确定短期和长期结果。
这是一项在爱因斯坦医疗中心进行的观察性病例对照队列研究。它包括所有 2003 年 5 月至 2007 年 4 月期间植入药物洗脱支架的患者。共确定了 1852 例患者；其中 50 例因 GI 出血而再次入院。将 202 例无任何 GI 出血证据的患者作为对照组与原始组进行比较。所有数据均表示为均数±标准差。使用 t 检验和 Fisher 确切检验比较两组间的基线临床特征。使用多变量分析确定 GI 出血的预测因素。
GI 出血率为 2.7%。GI 出血组的平均年龄为 70.9±12.2 岁，而无 GI 出血组的平均年龄为 66.5±12.8 岁（P<0.05）。大多数患者出现黑便（40%）。内镜检查发现胃炎和胃溃疡最为常见，占 49%的患者。多变量逻辑回归分析显示，GI 出血史是未来 GI 出血的最重要独立预测因素（P<0.001），而他汀类药物的使用被发现可预防（95%置信区间，0.13-0.48；P<0.001）未来的 GI 出血。GI 出血组和对照组的 30 天死亡率分别为 3.7%和 0%（P<0.01），而相应的 1 年死亡率分别为 18.9%和 0%（P<0.001）。
双联抗血小板治疗患者的 GI 出血率较低。较早的 GI 出血史是未来 GI 出血的最重要的多变量预测因素，而他汀类药物似乎具有保护作用。有 GI 出血的患者短期和长期死亡率增加；因此，在开始双联抗血小板治疗之前，需要仔细评估先前的 GI 出血史。这可能在这些患者的治疗策略选择中发挥重要作用。
