Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Internal Medicine, Division of Cardiology, Landspitali - The National University Hospital of Iceland, Reykajvik, Iceland.
Scand J Gastroenterol. 2021 Jun;56(6):733-739. doi: 10.1080/00365521.2021.1906945. Epub 2021 Apr 1.
Patients undergoing percutaneous coronary intervention (PCI) require dual antiplatelet therapy and some require additional anticoagulation. We aimed to investigate the incidence of acute gastrointestinal bleeding (AGIB) among PCI patients receiving antiplatelet and anticoagulant therapy.
A population-based study that included all patients undergoing PCI during 2008-2016 in Iceland. Data from the Icelandic Medicines Registry were obtained on all outpatient prescriptions 1 year after first PCI. Patients receiving single or dual-antiplatelet therapy with or without anticoagulation cotherapy were analyzed. Rehospitalization for AGIB and endoscopic data were obtained within the 12-month follow-up period.
A total of 5166 patients (male 75%) underwent PCI during the study period. The incidence of AGIB was 1% (54/5166) per year. The mean age among non-bleeders 65 (±11) years was lower than among bleeders 69 (±9) years ( = .002). The proportion of acute upper GIB (AUGIB) was 56%, whereas lower GIB occurred in 44%. Overall, 41% with AUGIB had PPIs compared to 39% of non-bleeders (NS). The incidence of AGIB among patients on single antiplatelet therapy combined with an anticoagulant was 2.5% compared to 0.9% among those on single antiplatelet treatment alone ( = .028). The number needed to harm (NNH) for treatment with single antiplatelet therapy and anticoagulant therapy compared to single antiplatelet therapy was 62 but no deaths related to AGIB.
The 1-year incidence of AGIB was low with no mortality. Bleeding risk was found to be higher among patients on single antiplatelet therapy combined with anticoagulant therapy compared to patients on single antiplatelet therapy alone.
接受经皮冠状动脉介入治疗（PCI）的患者需要接受双联抗血小板治疗，有些患者还需要额外的抗凝治疗。我们旨在研究接受抗血小板和抗凝治疗的 PCI 患者发生急性胃肠道出血（AGIB）的发生率。
这是一项基于人群的研究，纳入了 2008 年至 2016 年期间在冰岛接受 PCI 的所有患者。通过冰岛药品登记处获取所有患者首次 PCI 后 1 年的门诊处方数据。分析接受单一或双联抗血小板治疗联合或不联合抗凝联合治疗的患者。在 12 个月的随访期间，获取因 AGIB 再次住院和内镜数据。
在研究期间，共有 5166 名（75%为男性）患者接受了 PCI。每年发生 AGIB 的发生率为 1%（54/5166）。非出血患者的平均年龄为 65（±11）岁，低于出血患者的 69（±9）岁（ = .002）。急性上胃肠道出血（AUGIB）的比例为 56%，而下胃肠道出血占 44%。总体而言，AUGIB 患者中使用质子泵抑制剂（PPIs）的比例为 41%，而非出血患者中使用 PPI 的比例为 39%（NS）。与单独使用单一抗血小板治疗相比，联合使用单一抗血小板治疗和抗凝剂治疗的患者发生 AGIB 的发生率为 2.5%，而单独使用单一抗血小板治疗的患者发生率为 0.9%（ = .028）。与单独使用单一抗血小板治疗相比，联合使用单一抗血小板治疗和抗凝剂治疗的危害人数（NNH）为 62，但没有与 AGIB 相关的死亡病例。
AGIB 的 1 年发生率较低，且无死亡病例。与单独使用单一抗血小板治疗相比，联合使用单一抗血小板治疗和抗凝剂治疗的患者出血风险更高。
