Division of Cardiovascular Diseases, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
University of Kansas School of Medicine, Kansas City, Kansas, USA.
J Dig Dis. 2018 Feb;19(2):66-73. doi: 10.1111/1751-2980.12575.
Dual antiplatelet therapy (DAPT) is associated with an increased risk of gastrointestinal (GI) bleeding and is thought to cause upper gastrointestinal bleeding (UGIB). However, recent reports indicate that the incidence of lower gastrointestinal bleeding (LGIB) in patients on DAPT may be increasing. We aimed to compare the endoscopic findings and etiology of GI bleeding between patients on DAPT compared with those not on DAPT.
This was a retrospective, single-center, case-control study. Cases were 114 consecutive patients admitted with a first episode of GI bleeding while on DAPT who underwent detailed GI evaluation. We chose 114 controls who had GIB but were not on DAPT.
There was no significant difference in the incidence of UGIB or LGIB between the two groups (UGIB: 53.5% vs 51.3% and LGIB: 46.5% vs 48.7%, P = 0.10) or within groups (DAPT: 53.5% vs 46.5%, P = 0.30 and controls: 51.3% vs 48.7%, P = 0.80). Although the DAPT group had a lower prevalence of the usual UGIB risk factors, it had a higher likelihood of bleeding from varices or upper GI inflammation [odds ratio (OR) 3.54, 95% confidence interval (CI) 0.14-92.3; OR 13.98, 95% CI 1.40-140.36]. No etiology of bleeding was identified in a higher percentage of patients on DAPT than those who were not (22.8% vs 5.3%).
In patients with GI bleeding, the incidences of UGIB and LGIB are similar irrespective of their DAPT use.
双联抗血小板治疗（DAPT）会增加胃肠道（GI）出血的风险，并且被认为会导致上胃肠道出血（UGIB）。然而，最近的报告表明，接受 DAPT 的患者发生下胃肠道出血（LGIB）的比例可能正在增加。我们旨在比较接受 DAPT 和未接受 DAPT 的患者 GI 出血的内镜检查结果和病因。
这是一项回顾性、单中心、病例对照研究。病例为 114 例连续因 DAPT 期间首次出现 GI 出血而入院的患者，这些患者接受了详细的 GI 评估。我们选择了 114 例未接受 DAPT 且有 GIB 的对照患者。
两组间 UGIB 或 LGIB 的发生率无显著差异（UGIB：53.5%比 51.3%和 LGIB：46.5%比 48.7%，P=0.10）或组内差异（DAPT：53.5%比 46.5%，P=0.30 和对照：51.3%比 48.7%，P=0.80）。尽管 DAPT 组的常见 UGIB 危险因素发生率较低，但出血来自静脉曲张或上胃肠道炎症的可能性更高[比值比（OR）3.54，95%置信区间（CI）0.14-92.3；OR 13.98，95% CI 1.40-140.36]。与未接受 DAPT 的患者相比，接受 DAPT 的患者中更多的患者未确定出血病因（22.8%比 5.3%）。
在 GI 出血患者中，无论是否接受 DAPT，UGIB 和 LGIB 的发生率相似。
