抗血栓药物治疗期间不明原因胃肠道出血患者的临床结局

Clinical outcome of patients with obscure gastrointestinal bleeding during antithrombotic drug therapy.

作者信息

Kono Yoshiyasu, Kawano Seiji, Okamoto Yuki, Obayashi Yuka, Baba Yuki, Sakae Hiroyuki, Abe Makoto, Gotoda Tatsuhiro, Inokuchi Toshihiro, Kanzaki Hiromitsu, Iwamuro Masaya, Kawahara Yoshiro, Okada Hiroyuki

机构信息

Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.

Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.

出版信息

Therap Adv Gastroenterol. 2018 Jan 14;11:1756283X17746930. doi: 10.1177/1756283X17746930. eCollection 2018.

DOI:10.1177/1756283X17746930

PMID:29399040

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5788140/

Abstract

BACKGROUND

The clinical outcome of patients with obscure gastrointestinal bleeding (OGIB) during antithrombotic drug therapy has not been fully investigated.

METHODS

Patients who underwent video capsule endoscopy (VCE) for the investigation of OGIB at Okayama University Hospital from January 2009 to March 2016 were enrolled. We evaluated the VCE findings, the patterns of OGIB, and the rate of rebleeding within 1 year in antithrombotic drug users and antithrombotic drug nonusers.

RESULTS

A total of 181 patients were enrolled. Among the antithrombotic drug users, the rate of VCE positivity in the patients with overt OGIB was significantly higher in comparison with patients with occult OGIB (45% 16%, = 0.014), whereas there was no significant difference among the antithrombotic drug nonusers (27% 26%, = 1.0). Among the antithrombotic drug users, the rate of rebleeding among the VCE-positive patients was significantly higher in comparison with the VCE-negative patients (50% 5.9%, = 0.011). Moreover, among antithrombotic drug users who did not receive therapeutic intervention, the rate of rebleeding among the VCE-positive patients was significantly higher in comparison with the VCE-negative patients (75% 6.3%, = 0.001). However, among the antithrombotic drug nonusers who did not receive therapeutic intervention, the rebleeding rate of the VCE-positive patients was not significantly different from that of the VCE-negative patients (20% 9.4%, = 0.43).

CONCLUSION

Therapeutic intervention should be considered for patients with overt OGIB who are VCE positive and who use antithrombotic drugs due to the high risk of rebleeding.

摘要

背景

抗血栓药物治疗期间不明原因胃肠道出血（OGIB）患者的临床结局尚未得到充分研究。

方法

纳入2009年1月至2016年3月在冈山大学医院因OGIB接受视频胶囊内镜检查（VCE）的患者。我们评估了VCE检查结果、OGIB的类型以及抗血栓药物使用者和非使用者1年内的再出血率。

结果

共纳入181例患者。在抗血栓药物使用者中，显性OGIB患者的VCE阳性率显著高于隐匿性OGIB患者（45%对16%，P = 0.014），而在抗血栓药物非使用者中无显著差异（27%对26%，P = 1.0）。在抗血栓药物使用者中，VCE阳性患者的再出血率显著高于VCE阴性患者（50%对5.9%，P = 0.011）。此外，在未接受治疗干预的抗血栓药物使用者中，VCE阳性患者的再出血率显著高于VCE阴性患者（75%对6.3%，P = 0.001）。然而，在未接受治疗干预的抗血栓药物非使用者中，VCE阳性患者的再出血率与VCE阴性患者无显著差异（20%对9.4%，P = 0.43）。