Division of Gastroenterology, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
JAMA. 2011 Dec 7;306(21):2367-74. doi: 10.1001/jama.2011.1653. Epub 2011 Nov 1.
Bleeding in the upper gastrointestinal tract is a common medical problem, with an incidence of 48 to 160 cases per 1000 adults per year and a mortality rate of 5% to 14%. The risk of gastrointestinal bleeding is increased with the use of antiplatelet medications including aspirin and clopidogrel, as well as warfarin or a combination of these medications. The recurrence rate for bleeding in patients who continue to take aspirin after an episode of peptic ulcer disease-related bleeding can reach up to 300 cases per 1000 person-years and varies by age, sex, and the use of nonsteroidal anti-inflammatory medications. Using the case of Ms S, an 86-year-old woman who presented to the emergency department with an episode of nonvariceal upper gastrointestinal tract bleeding, we address the management of patients who are receiving antiplatelet or anticoagulation therapy who present with gastrointestinal bleeding, including when to restart antiplatelet or anticoagulation therapy, interventions to reduce the risk of bleeding recurrence, and the potential for drug interactions between clopidogrel and proton pump inhibitors.
上消化道出血是一种常见的医学问题，每年每千名成年人中有 48 至 160 例发病，死亡率为 5%至 14%。使用抗血小板药物（包括阿司匹林和氯吡格雷以及华法林或这些药物的联合用药）会增加胃肠道出血的风险。在因消化性溃疡疾病相关出血而继续服用阿司匹林的患者中，出血的复发率可高达每 1000 人年 300 例，其变化取决于年龄、性别和非甾体抗炎药物的使用情况。通过 86 岁女性 S 女士的病例，她因非静脉曲张性上消化道出血发作而到急诊就诊，我们讨论了正在接受抗血小板或抗凝治疗并出现胃肠道出血的患者的管理，包括何时重新开始抗血小板或抗凝治疗、减少出血复发风险的干预措施以及氯吡格雷和质子泵抑制剂之间可能发生的药物相互作用。
