Joint Advisory Group in Gastrointestinal Endoscopy, Royal College of Physicians, London.
Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley.
Postgrad Med J. 2018 Mar;94(1109):137-142. doi: 10.1136/postgradmedj-2017-135276. Epub 2017 Nov 3.
Antithrombotic drugs are often stopped following acute upper gastrointestinal bleeding (AUGIB) and frequently not restarted. The practice of antithrombotic discontinuation on discharge and its impact on outcomes are unclear.
To assess whether restarting antithrombotic therapy, prior to hospital discharge for AUGIB, affected clinical outcomes.
Retrospective cohort study.
University hospital between May 2013 and November 2014, with median follow-up of 259 days.
Patients who underwent gastroscopy for AUGIB while on antithrombotic therapy.
Continuation or cessation of antithrombotic(s) at discharge.
Cause-specific mortality, thrombotic events, rebleeding and serious adverse events (any of the above).
Of 118 patients analysed, antithrombotic treatment was stopped in 58 (49.2%). Older age, aspirin monotherapy and peptic ulcer disease were significant predictors of antithrombotic discontinuation, whereas dual antiplatelet use predicted antithrombotic maintenance. The 1-year postdischarge mortality rate was 11.3%, with deaths mainly due to thrombotic causes. Stopping antithrombotic therapy at the time of discharge was associated with increased mortality (HR 3.32; 95% CI 1.07 to 10.31, P=0.027), thrombotic events (HR 5.77; 95% CI 1.26 to 26.35, P=0.010) and overall adverse events (HR 2.98; 95% CI 1.32 to 6.74, P=0.006), with effects persisting after multivariable adjustment for age and peptic ulcer disease. On subgroup analysis, the thromboprotective benefit remained significant with continuation of non-aspirin regimens (P=0.016). There were no significant differences in postdischarge bleeding rates between groups (HR 3.43, 0.36 to 33.04, P=0.255).
In this hospital-based study, discontinuation of antithrombotic therapy is associated with increased thrombotic events and reduced survival.
急性上消化道出血（AUGIB）后常停止使用抗血栓药物，且常不再重新使用。抗血栓药物停用的出院情况及其对结局的影响尚不清楚。
评估 AUGIB 出院前重新开始抗血栓治疗是否会影响临床结局。
回顾性队列研究。
2013 年 5 月至 2014 年 11 月期间的大学医院，中位随访时间为 259 天。
接受 AUGIB 胃镜检查的同时正在接受抗血栓治疗的患者。
出院时继续或停止抗血栓治疗。
特定原因死亡率、血栓形成事件、再出血和严重不良事件（上述任何一种）。
在 118 例分析患者中，58 例（49.2%）停止了抗血栓治疗。年龄较大、阿司匹林单药治疗和消化性溃疡病是抗血栓药物停药的显著预测因素，而双联抗血小板治疗则预测抗血栓药物维持。出院后 1 年死亡率为 11.3%，死亡主要归因于血栓形成原因。出院时停止抗血栓治疗与死亡率增加（HR 3.32；95%CI 1.07 至 10.31，P=0.027）、血栓形成事件（HR 5.77；95%CI 1.26 至 26.35，P=0.010）和总体不良事件（HR 2.98；95%CI 1.32 至 6.74，P=0.006）相关，且在多变量调整年龄和消化性溃疡病后仍存在影响。在亚组分析中，继续非阿司匹林方案的血栓保护益处仍然显著（P=0.016）。两组间出院后出血率无显著差异（HR 3.43，0.36 至 33.04，P=0.255）。
在这项基于医院的研究中，抗血栓药物停用与血栓形成事件增加和生存率降低有关。
