Gutermann Irit Kaye, Niggemeier Verena, Zimmerli Lukas U, Holzer Barbara M, Battegay Edouard, Scharl Michael
From the Division of Internal Medicine (IKG, VN, LUZ, BMH, EB, MS); Center of Competence Multimorbidity (LUZ, BMH, EB); The University Research Priority Program "Dynamics of Healthy Aging" (EB); Zurich Center for Integrative Human Physiology (EB, MS); and Division of Gastroenterology and Hepatology (MS), University Hospital Zurich, Zurich, Switzerland.
Medicine (Baltimore). 2015 Jan;94(1):e377. doi: 10.1097/MD.0000000000000377.
Gastrointestinal (GI) bleeding is a frequently encountered and very serious problem in emergency room patients who are currently being treated with anticoagulant or antiplatelet medications. There is, however, a lack of clinical practice guidelines about how to respond to these situations. The goal of this study was to find published articles that contain specific information about how to safely adjust anticoagulant and antiplatelet therapy when GI bleeding occurs.The investigators initiated a global search on the PubMed and Google websites for published information about GI bleeding in the presence of anticoagulant or antiplatelet therapy. After eliminating duplicate entries, the medical articles that remained were screened to narrow the sets of articles to those that met specific criteria. Articles that most closely matched study criteria were analyzed in detail and compared to determine how many actual guidelines exist and are useful.We could provide only minimal information about appropriate therapeutic strategies because no articles provided sufficient specific advice about how to respond to situations involving acute GI bleeding and concurrent use of anticoagulant or antiplatelet drugs. Only 4 articles provided enough detail to be of any use in an emergency situation.Clinical practice guidelines and also clinical trials for GI hemorrhaging should be expanded to state in which situations the use of anticoagulant or antiplatelet drugs should be suspended and the medications should later be resumed, and they should state the level of risk for any particular action.
胃肠道（GI）出血在目前正在接受抗凝或抗血小板药物治疗的急诊患者中是一个经常遇到且非常严重的问题。然而，对于如何应对这些情况缺乏临床实践指南。本研究的目的是查找已发表的文章，这些文章包含有关胃肠道出血发生时如何安全调整抗凝和抗血小板治疗的具体信息。研究人员在PubMed和谷歌网站上进行了全面搜索，以获取有关在抗凝或抗血小板治疗情况下胃肠道出血的已发表信息。在消除重复条目后，对剩余的医学文章进行筛选，以将文章集缩小到符合特定标准的文章。对最符合研究标准的文章进行详细分析和比较，以确定实际存在且有用的指南数量。由于没有文章提供足够的具体建议来应对涉及急性胃肠道出血以及同时使用抗凝或抗血小板药物的情况，我们只能提供关于适当治疗策略的极少信息。只有4篇文章提供了足够详细的信息，在紧急情况下有任何用处。胃肠道出血的临床实践指南以及临床试验应加以扩展，以说明在哪些情况下应暂停使用抗凝或抗血小板药物，随后又应恢复用药，并且应说明任何特定行动的风险程度。
