Wilcox C M, Truss C D
Department of Medicine, University of Alabama, Birmingham 35294.
Am J Med. 1988 Apr;84(4):683-90. doi: 10.1016/0002-9343(88)90105-2.
When gastrointestinal (Gl) bleeding occurs in patients receiving anticoagulation, an underlying pathologic lesion is usually suspected and a thorough diagnostic evaluation is undertaken. Over a 15-year period, 50 patients were identified as having Gl bleeding while receiving warfarin. Approximately half of all bleeding episodes occurred from the upper Gl tract, with a lesion identified 81 percent of the time, usually peptic ulcer disease. Lower Gl bleeding occurred in one-third of bleeding episodes, with a diagnosis made in only 52 percent. Only three neoplasms were found and all were diagnosed by barium studies. No diagnosis was established in 47 percent of all bleeding episodes despite appropriate evaluation; in these patients, a mean follow-up of 39.6 months disclosed no premalignant or malignant lesions. Mortality associated with bleeding was less than 2 percent. These data suggest that a diagnosis is usually established in patients receiving anticoagulation who experience upper Gl bleeding, whereas the cause of lower Gl bleeding may remain occult even after a thorough evaluation; however, the absence of a definitive diagnosis carries a good prognosis.
接受抗凝治疗的患者发生胃肠道（GI）出血时，通常会怀疑存在潜在的病理病变，并进行全面的诊断评估。在15年的时间里，有50名患者在接受华法林治疗时被确定发生了GI出血。所有出血事件中约一半发生在上消化道，81%的情况下能发现病变，通常为消化性溃疡病。下消化道出血占出血事件的三分之一，仅52%能做出诊断。仅发现3例肿瘤，均通过钡剂造影检查确诊。尽管进行了适当评估，但47%的出血事件仍未明确诊断；在这些患者中，平均随访39.6个月未发现癌前或恶性病变。与出血相关的死亡率低于2%。这些数据表明，接受抗凝治疗且发生上消化道出血的患者通常能确诊病因，而下消化道出血的病因即使经过全面评估仍可能不明；然而，未明确诊断的预后良好。
