Department of Gastroenterology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).
Med Sci Monit. 2022 Jul 23;28:e936953. doi: 10.12659/MSM.936953.
BACKGROUND This study aimed to investigate the optimum time to reintroduce the original antiplatelet drugs after upper gastrointestinal hemorrhage in patients as secondary prevention for cardiovascular and cerebrovascular diseases. MATERIAL AND METHODS After the upper gastrointestinal bleeding stopped, patients were randomly divided according to the oral antiplatelet drugs administered. The aspirin group was further divided into 3-day and 7-day aspirin groups. The patients who took aspirin and clopidogrel were randomly divided into 3 groups: 0-day aspirin+3-day clopidogrel; 0-day aspirin+7-day clopidogrel; and 3-day aspirin+7-day clopidogrel. The recovery time, rebleeding rate, incidence of cardiovascular and cerebrovascular events, and death were observed. RESULTS The 3-day aspirin group had more rebleeding, reduced risk of cardiovascular and cerebrovascular events, and a similar mortality rate compared to the other groups. In the aspirin+clopidogrel group, the 0-day aspirin+3-day clopidogrel group had the highest rebleeding rate and the lowest risk of cardiovascular and cerebrovascular events. The 3-day aspirin+7-day clopidogrel group had the highest risk of cardiovascular and cerebrovascular events and increased hospitalization time. The risk of rebleeding and cardiovascular and cerebrovascular events was lower in the 0-day aspirin+7-day clopidogrel group, and the overall mortality rate was the lowest in this group. CONCLUSIONS In patients receiving only aspirin, this drug should be reintroduced as soon as possible after peptic ulcer hemorrhage. Aspirin and clopidogrel are dual antiplatelet drugs used for the secondary prevention of cardiovascular diseases. In patients under dual-drug therapy, aspirin should not be stopped, while clopidogrel should be restarted in about 7 days.
本研究旨在探讨上消化道出血后患者再次使用抗血小板药物进行心血管和脑血管疾病二级预防的最佳时间。
上消化道出血停止后，根据口服抗血小板药物的不同，患者随机分组。阿司匹林组再分为 3 天和 7 天阿司匹林组。服用阿司匹林和氯吡格雷的患者随机分为 3 组：0 天阿司匹林+3 天氯吡格雷；0 天阿司匹林+7 天氯吡格雷；3 天阿司匹林+7 天氯吡格雷。观察恢复时间、再出血率、心血管和脑血管事件发生率及死亡率。
与其他组相比，3 天阿司匹林组再出血更多，心血管和脑血管事件风险降低，死亡率相似。在阿司匹林+氯吡格雷组中，0 天阿司匹林+3 天氯吡格雷组再出血率最高，心血管和脑血管事件风险最低。3 天阿司匹林+7 天氯吡格雷组心血管和脑血管事件风险最高，住院时间延长。0 天阿司匹林+7 天氯吡格雷组再出血和心血管及脑血管事件风险较低，总死亡率最低。
在上消化道出血患者中，仅使用阿司匹林时，应在消化性溃疡出血后尽快重新使用该药物。阿司匹林和氯吡格雷是用于心血管疾病二级预防的双重抗血小板药物。在双联药物治疗患者中，不应停用阿司匹林，而应在大约 7 天内重新开始使用氯吡格雷。
