Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
IIS Aragón, Zaragoza, Spain.
Aliment Pharmacol Ther. 2019 Oct;50(8):919-929. doi: 10.1111/apt.15441. Epub 2019 Sep 4.
Patients with gastrointestinal bleeding during anticoagulant and/or antiplatelet therapy represent a clinical challenge.
To determine the risk/rates of rebleeding, vascular events and death in patients treated with antiplatelet or anticoagulant agents who developed major gastrointestinal bleeding METHODS: This was an observational cohort study of patients who developed gastrointestinal bleeding while on antiplatelet and/or anticoagulant therapy. Drug use information was collected prospectively during bleeding events. Cox proportional hazards models were used to evaluate rebleeding, vascular events and death.
Among 871 patients (mean age 78.9 ± 8.6 years), 38.9% used an anticoagulant, 52.5% used an antiplatelet and 8.6% used both; 93.1% interrupted treatment after gastrointestinal bleeding and 80.5% restarted therapy within 7.6 ± 36.4 days; 38.7% had upper gastrointestinal bleeds, 46.7% lower gastrointestinal bleeds and 14.6% gastrointestinal bleeds of unknown origin. Median follow-up was 24.9 months (IQR: 7.0-38.0). Resumption of both therapies was associated with a higher risk of rebleeding, lower risk of ischaemic events or death and a similar risk for upper and lower gastrointestinal events. Resumption of therapy ≤ 7 days after bleeding showed a similar pattern with no differences in death. Rebleeding rates were higher in anticoagulant vs antiplatelet patients (138.0 vs 99.0 events per 1000 patient-years), and the bleeding location was identical in 61.8% of cases.
Resumption of anticoagulant or antiplatelet therapy after a gastrointestinal bleeding event was associated with a lower risk of vascular events and death and a higher rebleeding risk. The benefits of early reinstitution of anticoagulant/antiplatelet therapy outweigh the gastrointestinal-related risks.
在接受抗凝和/或抗血小板治疗的患者中出现胃肠道出血是一个临床挑战。
确定在发生主要胃肠道出血时接受抗血小板或抗凝药物治疗的患者再出血、血管事件和死亡的风险/发生率。
这是一项观察性队列研究，纳入了在接受抗血小板和/或抗凝治疗期间发生胃肠道出血的患者。在出血事件期间前瞻性地收集药物使用信息。使用 Cox 比例风险模型评估再出血、血管事件和死亡。
在 871 名患者（平均年龄 78.9±8.6 岁）中，38.9%使用抗凝剂，52.5%使用抗血小板药物，8.6%两者均使用；93.1%的患者在胃肠道出血后中断治疗，80.5%在 7.6±36.4 天内重新开始治疗；38.7%为上消化道出血，46.7%为下消化道出血，14.6%为胃肠道出血来源不明。中位随访时间为 24.9 个月（IQR：7.0-38.0）。两种治疗方法的恢复与再出血风险增加、缺血性事件或死亡风险降低以及上、下消化道事件风险相似相关。出血后≤7 天恢复治疗显示出类似的模式，死亡无差异。与抗血小板患者相比，抗凝剂患者的再出血发生率更高（每 1000 患者年发生 138.0 与 99.0 次事件），61.8%的情况下出血部位相同。
在胃肠道出血事件后恢复抗凝或抗血小板治疗与血管事件和死亡风险降低以及再出血风险增加相关。早期重新开始抗凝/抗血小板治疗的益处超过了胃肠道相关风险。
