Kawasaki Keisuke, Kurahara Koichi, Yanai Shunichi, Kochi Shuji, Fuchigami Tadahiko, Matsumoto Takayuki
Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, 020-8505, Japan,
Dig Dis Sci. 2015 Apr;60(4):1010-5. doi: 10.1007/s10620-014-3415-9. Epub 2014 Nov 1.
Non-steroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin (LDA), non-aspirin antiplatelet medications (APs), and anticoagulant medications (ACs) increase the risk of gastrointestinal bleeding.
To examine whether NSAIDs, LDA, APs, and ACs use is associated with bleeding from gastroduodenal ulcers.
This was a case-control study of patients with endoscopically verified gastroduodenal ulcer diagnosed at our institution from 2004 to 2011. Among 1,611 patients, we identified those who required endoscopic hemostasis for bleeding ulcers as cases. Age-matched, sex-matched, and Helicobacter pylori status-matched patients who did not require therapeutic interventions served as controls. Use of NSAIDs, LDA, APs, and ACs within 2 weeks prior to the endoscopy was compared between cases and controls, and effects on ulcer bleeding were calculated.
We recruited 341 cases and 668 controls. The site and number of ulcers were not different between groups. Multivariate analyses revealed that LDA and NSAIDs, individually, were associated with the increase in the risk of bleeding (OR 1.80 and 95 % CI 1.18-2.75 for LDA; 1.35 and 1.01-1.80 for NSAIDs). In addition, a combination of LDA and NSAIDs or LDA and APs contributed more profoundly to the bleeding (OR 3.59 and 95 % CI 1.19-10.81 for LDA/NSAIDs; OR 6.70 and 95 % CI 1.83-24.50 for LDA/APs). However, ACs, alone or in combination, were not associated with bleeding ulcers.
Both LDA and NSAIDs are risk factors for upper GI bleeding in patients with gastroduodenal ulcer, while ACs are unrelated to the increased risk. The risk of bleeding with LDA may increase with simultaneous use of APs.
非甾体抗炎药（NSAIDs）、低剂量阿司匹林（LDA）、非阿司匹林抗血小板药物（APs）和抗凝药物（ACs）会增加胃肠道出血风险。
研究NSAIDs、LDA、APs和ACs的使用是否与胃十二指肠溃疡出血相关。
这是一项病例对照研究，研究对象为2004年至2011年在我院经内镜确诊为胃十二指肠溃疡的患者。在1611例患者中，我们将因溃疡出血需要内镜止血的患者确定为病例组。年龄、性别和幽门螺杆菌感染状况相匹配且无需治疗干预的患者作为对照组。比较病例组和对照组在内镜检查前2周内NSAIDs、LDA、APs和ACs的使用情况，并计算其对溃疡出血的影响。
我们招募了341例病例和668例对照。两组之间溃疡的部位和数量没有差异。多因素分析显示，LDA和NSAIDs单独使用均与出血风险增加相关（LDA的OR为1.80，95%CI为1.18 - 2.75；NSAIDs的OR为1.35，95%CI为1.01 - 1.80）。此外，LDA与NSAIDs或LDA与APs联合使用对出血的影响更大（LDA/NSAIDs的OR为3.59，95%CI为1.19 - 10.81；LDA/APs的OR为6.70，95%CI为1.83 - 24.50）。然而，ACs单独或联合使用与溃疡出血无关。
LDA和NSAIDs均是胃十二指肠溃疡患者上消化道出血的危险因素，而ACs与出血风险增加无关。LDA与APs同时使用时出血风险可能增加。
