Nadatani Yuji, Watanabe Toshio, Tanigawa Tetsuya, Sogawa Mitsue, Yamagami Hirokazu, Shiba Masatsugu, Watanabe Kenji, Tominaga Kazunari, Fujiwara Yasuhiro, Yoshiyama Minoru, Arakawa Tetsuo
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Scand J Gastroenterol. 2013 Mar;48(3):320-5. doi: 10.3109/00365521.2012.758771. Epub 2013 Jan 8.
Low-dose aspirin (LDA) is the most commonly prescribed antiplatelet agent for prevention of cardiovascular events following percutaneous coronary intervention (PCI). Long-term treatment with LDA has serious adverse effects, including gastrointestinal (GI) hemorrhage. Most studies have focused only on upper GI bleeding and few studies have evaluated the effect of LDA on total GI bleeding.
The aims of this study were to investigate the incidence and risk factors of total GI bleeding within 30 days after PCI in Japanese patients taking LDA.
A retrospective chart review was conducted for 364 patients undergoing LDA therapy following PCI at Osaka City University Hospital. A retrospective case-control study evaluated risk factors using the chi-squared test and logistic regression.
The incidence of total GI bleeding after PCI within 30 days was 4.3%. The source of the GI bleeding was located throughout the GI tract. Risk factors identified by univariate analysis were age ≥ 75 years, history of peptic ulcer disease, chronic renal failure, proton pump inhibitor use, and histamine H2 receptor antagonist use. By multivariate logistic regression only age ≥ 75 years (odds ratio = 5.26; 95% confidence interval: 1.13-24.51; p = 0.035) was found to be an independent risk factor of GI bleeding.
The incidence of GI bleeding in patients undergoing LDA therapy following PCI is high. The bleeding episodes were located in the upper, middle, and lower GI tract. Age of ≥ 75 years was an independent risk factor for GI bleeding after PCI in patients on LDA therapy.
低剂量阿司匹林（LDA）是经皮冠状动脉介入治疗（PCI）后预防心血管事件最常用的抗血小板药物。长期使用LDA有严重不良反应，包括胃肠道（GI）出血。大多数研究仅关注上消化道出血，很少有研究评估LDA对全胃肠道出血的影响。
本研究旨在调查日本接受LDA治疗的PCI患者术后30天内全胃肠道出血的发生率及危险因素。
对大阪市立大学医院364例PCI术后接受LDA治疗的患者进行回顾性病历审查。采用卡方检验和逻辑回归进行回顾性病例对照研究以评估危险因素。
PCI术后30天内全胃肠道出血的发生率为4.3%。胃肠道出血的部位遍布整个胃肠道。单因素分析确定的危险因素为年龄≥75岁、消化性溃疡病史、慢性肾功能衰竭、使用质子泵抑制剂和使用组胺H2受体拮抗剂。多因素逻辑回归分析仅发现年龄≥75岁（比值比=5.26；95%置信区间：1.13 - 24.51；p = 0.035）是胃肠道出血的独立危险因素。
PCI术后接受LDA治疗的患者胃肠道出血发生率较高。出血事件发生在上、中、下消化道。年龄≥75岁是LDA治疗的PCI患者术后胃肠道出血的独立危险因素。
