Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minnesota; Yale School of Medicine, New Haven, Connecticut.
Yale School of Medicine, New Haven, Connecticut.
Clin Gastroenterol Hepatol. 2017 Jan;15(1):46-52. doi: 10.1016/j.cgh.2016.07.017. Epub 2016 Jul 25.
BACKGROUND & AIMS: Antiplatelet agents decrease cardiovascular events but increase gastrointestinal bleeding (GIB). Guidelines propose platelet transfusion for patients who take antiplatelet agents and have serious GIB. We investigated whether such patients are at decreased risk for rebleeding or increased risk for cardiovascular events after platelet transfusion.
We performed a retrospective cohort study of patients with GIB admitted to Yale-New Haven Hospital from 2008 to 2013 who were taking antiplatelet agents and had platelet counts higher than 100 × 10/L. Cases (patients who received platelet transfusion, n = 204) were matched with controls (no platelet transfusions, n = 204) for sex, age, and GIB location. The primary outcome was recurrent GIB. Multivariable regression analyses were performed to adjust for differences in baseline characteristics.
Cases and controls had similar proportions of GIB due to non-variceal upper GIB (117 of 204, 57% vs 115 of 204, 56%) and colonic GIB (80 of 204, 39% vs 81 of 204, 40%). Cases had more severe GIB than controls, which was based on lower blood pressure and hemoglobin levels and higher heart rates and the proportion admitted to intensive care. Univariate analyses showed that higher proportions of cases had major cardiovascular events (23% vs 13% for controls), died (7% vs 1% for controls), or had hospital stay longer than 4 days (47% vs 33% for controls). However, multivariable analyses showed a significant difference between cases and controls in only risk of death (odds ratio, 5.57; 95% confidence interval, 1.52-27.1). The adjusted odds ratio for recurrent bleeding was 1.47 (95% confidence interval, 0.73-3.05) for cases vs controls.
The use of platelet transfusions in patients with GIB who are taking antiplatelet agents without thrombocytopenia did not reduce rebleeding but was associated with higher mortality. At least some of the increase in mortality could be due to the residual bias of an observational study, but because of the lack of benefit, we do not support the use of platelet transfusions in patients with GIB who are taking antiplatelet agents.
抗血小板药物可降低心血管事件发生率，但会增加胃肠道出血（GIB）风险。指南建议对服用抗血小板药物且出现严重 GIB 的患者进行血小板输注。我们研究了此类患者在输注血小板后是否会降低再出血风险或增加心血管事件风险。
我们对 2008 年至 2013 年在耶鲁纽黑文医院因 GIB 入院且正在服用抗血小板药物且血小板计数高于 100×10/L 的患者进行了一项回顾性队列研究。病例组（接受血小板输注的患者，n=204）与对照组（未接受血小板输注的患者，n=204）在性别、年龄和 GIB 部位方面进行了匹配。主要结局为复发性 GIB。采用多变量回归分析来调整基线特征差异。
病例组和对照组因非静脉曲张性上 GIB（117 例 vs 115 例，57% vs 56%）和结肠 GIB（80 例 vs 81 例，39% vs 40%）而发生 GIB 的比例相似。病例组的 GIB 严重程度高于对照组，表现为较低的血压和血红蛋白水平、较高的心率以及更多患者入住重症监护病房。单变量分析显示，更高比例的病例组发生重大心血管事件（23% vs 13%的对照组）、死亡（7% vs 1%的对照组）或住院时间超过 4 天（47% vs 33%的对照组）。然而，多变量分析仅显示病例组和对照组在死亡风险方面存在显著差异（比值比，5.57；95%置信区间，1.52-27.1）。病例组的复发性出血调整比值比为 1.47（95%置信区间，0.73-3.05）。
在服用抗血小板药物且无血小板减少症的 GIB 患者中使用血小板输注并不能降低再出血风险，但与更高的死亡率相关。至少部分死亡率增加可能是由于观察性研究的残余偏倚所致，但由于缺乏获益，我们不支持在服用抗血小板药物的 GIB 患者中使用血小板输注。
