Servicio de Aparato Digestivo, Hospital Clínico, University of Zaragoza, Zaragoza, Spain; CIBERehd, Barcelona, Spain.
CIBERehd, Barcelona, Spain.
Clin Gastroenterol Hepatol. 2015 May;13(5):906-12.e2. doi: 10.1016/j.cgh.2014.11.007. Epub 2014 Nov 14.
BACKGROUND & AIMS: Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin is associated with increased risk of upper gastrointestinal bleeding. There is little evidence on the risk of lower gastrointestinal bleeding with NSAIDs, antiplatelet agents (APAs), or anticoagulants. We aimed to quantify the relative risk (RR) of upper and lower gastrointestinal bleeding associated with use of NSAIDs, APAs, or anticoagulants.
We performed a case-control study that used data collected from consecutive patients hospitalized for gastrointestinal bleeding (563 upper, mean age, 63.6 ± 16.7 years and 415 lower, mean age, 70.8 ± 13.8 years), confirmed by endoscopy or other diagnostic procedures. Unhospitalized patients were used as controls (n = 1008) and matched for age, hospital, and month of admission. Drug use was considered current when taken within 7 days or less before hospitalization. RRs and 95% confidence intervals (CIs) were estimated by unconditional logistic regression analysis.
Use of anticoagulants, low-dose aspirin, and other drugs (non-aspirin-APA, 82.3% thienopiridines) was associated with upper and lower gastrointestinal bleeding; the risk was 2-fold higher for anticoagulants (RR, 4.2; 95% CI, 2.9-6.2) than for low-dose aspirin (RR, 2.1; 95% CI, 1.4-3.3) or other non-aspirin-APA drugs (RR, 2.0; 95% CI, 1.6-2.6). NSAID use was also associated with increased risk of gastrointestinal bleeding and greater for upper (RR, 2.6; 95% CI, 2.0-3.5) than lower gastrointestinal bleeding (RR, 1.4; 95% CI, 1.0-1.9). Use of proton pump inhibitors was associated with reduced risk of upper, but not lower, gastrointestinal bleeding.
Anticoagulants, low-dose aspirin, NSAIDs, and other non-aspirin-APA drugs are associated with increased risk of upper and lower gastrointestinal bleeding. Use of anticoagulants appears to be the strongest risk factor for gastrointestinal bleeding.
使用非甾体抗炎药（NSAIDs）或低剂量阿司匹林与上消化道出血的风险增加相关。关于 NSAIDs、抗血小板药物（APAs）或抗凝剂与下消化道出血风险的证据很少。我们旨在量化使用 NSAIDs、APAs 或抗凝剂与上消化道和下消化道出血相关的相对风险（RR）。
我们进行了一项病例对照研究，该研究使用了连续因胃肠道出血住院患者的数据（563 例上消化道出血，平均年龄 63.6 ± 16.7 岁和 415 例下消化道出血，平均年龄 70.8 ± 13.8 岁），这些出血通过内镜或其他诊断程序得到证实。未住院的患者被用作对照（n=1008），并按年龄、医院和入院月份进行匹配。当药物在住院前 7 天或更短时间内服用时，被认为是当前用药。通过无条件逻辑回归分析估计 RR 和 95%置信区间（CI）。
抗凝剂、低剂量阿司匹林和其他药物（非阿司匹林-APA，82.3%噻吩吡啶）的使用与上消化道和下消化道出血相关；抗凝剂的风险是低剂量阿司匹林（RR，2.1；95%CI，1.4-3.3）或其他非阿司匹林-APA 药物（RR，2.0；95%CI，1.6-2.6）的两倍（RR，4.2；95%CI，2.9-6.2）。NSAID 使用也与胃肠道出血风险增加相关，且对上消化道出血（RR，2.6；95%CI，2.0-3.5）的风险大于下消化道出血（RR，1.4；95%CI，1.0-1.9）。质子泵抑制剂的使用与上消化道出血风险降低相关，但与下消化道出血无关。
抗凝剂、低剂量阿司匹林、NSAIDs 和其他非阿司匹林-APA 药物与上消化道和下消化道出血的风险增加相关。抗凝剂的使用似乎是胃肠道出血的最强危险因素。
