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[药物性胃肠道出血]

[Drug-induced gastrointestinal bleeding].

作者信息

Fischbach W

机构信息

Gastroenterologie und Innere Medizin Aschaffenburg, Elisenstraße 32, 63739, Aschaffenburg, Deutschland.

Ehemals Medizinische Klinik II, Klinikum Aschaffenburg-Alzenau, Akademisches Krankenhaus der Universität Würzburg, Aschaffenburg, Deutschland.

出版信息

Internist (Berl). 2019 Jun;60(6):597-607. doi: 10.1007/s00108-019-0610-y.

Abstract

Gastrointestinal bleeding is a common and sometimes life-threatening event in older people. There is often a drug-induced cause. Drugs that can lead to gastrointestinal bleeding include non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac and ibuprofen, platelet inhibitors such as acetylsalicylic acid (ASS), clopidogrel and prasugrel, as well as anticoagulants like vitamin-K antagonists, heparin or direct oral anticoagulants (DOAKs). Combination antiplatelet therapy or combined medication with platelet inhibitor and anticoagulants increase the risk of gastrointestinal bleeding compared to monotherapy. Primary and secondary prevention options include Helicobacter pylori eradication and co-medication with a proton pump inhibitor (PPI).

摘要

胃肠道出血在老年人中是一种常见且有时会危及生命的事件。其病因通常由药物引起。可导致胃肠道出血的药物包括双氯芬酸和布洛芬等非甾体抗炎药(NSAIDs)、乙酰水杨酸(ASS)、氯吡格雷和普拉格雷等血小板抑制剂,以及维生素K拮抗剂、肝素或直接口服抗凝剂(DOACs)等抗凝剂。与单一疗法相比,联合抗血小板治疗或血小板抑制剂与抗凝剂的联合用药会增加胃肠道出血的风险。一级和二级预防措施包括根除幽门螺杆菌以及与质子泵抑制剂(PPI)联合用药。

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