Carlin Neal, Asslo Fady, Sison Raymund, Shaaban Hamid, Baddoura Walid, Manji Faiza, Depasquale Joseph
Department of Internal Medicine and Gastroenterology, St Joseph's Regional Medical Center, Paterson, NJ, USA.
Department of Internal Medicine and Hematology/Oncology, St Michael's Medical Center, Newark, NJ, USA.
J Emerg Trauma Shock. 2017 Jul-Sep;10(3):98-102. doi: 10.4103/JETS.JETS_110_15.
Dual antiplatelet (Plt) therapy with aspirin and clopidogrel is recommended for up to 1 year following acute coronary syndrome. Many of these cardiac patients are also on anithrombotic therapy like warfarin. Lower gastrointestinal bleeding (LGIB) is the main adverse event of this treatment.
The main purpose of this study was to analyze the relationship of dual anti-Plt therapy and the risk of LGIB.
Patients' electronic charts were reviewed to include a total of 19 variables, which included age, sex, ethnicity, daily use aspirin of any dose, daily use of clopidogrel, use of nonsteroidal anti-inflammatory drugs (NSAIDs) at least twice in the last week prior to admission and the daily use of anticoagulants (warfarin, heparin), and were obtained from history and physical examination reports, lab transcripts and procedural reports.
SETTINGS/DESIGN: A retrospective cohort study of the records of 3436 patients admitted to our hospital from January 1, 2009, to December 31, 2011, was evaluated. All the patients included were admitted through the emergency department with complaints of or relating to LGIB. The primary outcome studied was severe LGIB as defined by the requirement of at least two units of packed red blood cells and/or a decrease in the hematocrit of 20% or more or recurrent bleeding after 24 h of clinical stability with additional transfusions required. Other outcomes included surgical intervention.
STATISTICAL METHODS/ANALYSIS: Univariate analysis using -test on continuous variables and Chi-square test on categorical variables were done before carrying out logistic regression analysis. Logistic regression analyses were conducted to measures of association between the variables and LGIB. Logistic regression analysis was not carried for surgical intervention and death because none of the variables was significant from univariate tests.
A total of 511 patients were found to have true LGIB. Among these subjects, 61 were shown to be on dual or multiple antithrombotic therapies. Further exploration revealed that while the use of multiple blood thinning agents may, in fact, pose a significant risk to overall LGIB, it did not significantly increase the risk for severe bleeding as outlined above.
The use of multiple blood thinning agents does not significantly increase the risk for severe LGIB.
对于急性冠状动脉综合征患者，推荐阿司匹林和氯吡格雷双联抗血小板治疗，疗程长达1年。许多此类心脏病患者同时也在接受华法林等抗栓治疗。下消化道出血（LGIB）是这种治疗的主要不良事件。
本研究的主要目的是分析双联抗血小板治疗与LGIB风险之间的关系。
查阅患者电子病历，纳入总共19个变量，包括年龄、性别、种族、任何剂量阿司匹林的每日使用情况、氯吡格雷的每日使用情况、入院前最后一周内至少两次使用非甾体抗炎药（NSAIDs）以及抗凝剂（华法林、肝素）的每日使用情况，这些信息来自病史和体格检查报告、实验室记录及诊疗报告。
设置/设计：对我院2009年1月1日至2011年12月31日收治的3436例患者的记录进行回顾性队列研究。所有纳入患者均因LGIB相关主诉经急诊科入院。所研究的主要结局为严重LGIB，定义为至少需要两个单位的浓缩红细胞和/或血细胞比容降低20%或更多，或临床稳定24小时后再次出血且需要额外输血。其他结局包括手术干预。
统计方法/分析：在进行逻辑回归分析之前，对连续变量采用t检验、对分类变量采用卡方检验进行单因素分析。进行逻辑回归分析以衡量变量与LGIB之间的关联度。未对手术干预和死亡进行逻辑回归分析，因为单因素检验中没有变量具有显著性。
共发现511例患者存在真正的LGIB。在这些受试者中，61例接受双联或多种抗栓治疗。进一步探究发现，虽然使用多种血液稀释剂实际上可能对总体LGIB构成显著风险，但并未显著增加上述严重出血的风险。
使用多种血液稀释剂不会显著增加严重LGIB的风险。
