2016-2020 年全国急诊样本分析：初级预防阿司匹林治疗患者上消化道出血趋势。
Trends in Upper Gastrointestinal Bleeding in Patients on Primary Prevention Aspirin: A Nationwide Emergency Department Sample Analysis, 2016-2020.
机构信息
Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Conn.
Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Conn; VA Connecticut Healthcare System, West Haven, Conn.
出版信息
Am J Med. 2023 Dec;136(12):1179-1186.e1. doi: 10.1016/j.amjmed.2023.08.010. Epub 2023 Sep 9.
BACKGROUND
Recent guidelines do not recommend routine use of aspirin for primary cardiovascular prevention (ppASA) and suggest avoidance of ppASA in older individuals due to bleeding risk. However, ppASA is frequently taken without an appropriate indication. Estimates of the incidence of upper gastrointestinal bleeding due to ppASA in the United States are lacking. In this study, we provide national estimates of upper gastrointestinal bleeding incidence, characteristics, and costs in ppASA users from 2016-2020.
METHODS
Primary cardiovascular prevention users (patients on long-term aspirin therapy without cardiovascular disease) presenting with upper gastrointestinal bleeding were identified in the Nationwide Emergency Department Sample using International Statistical Classification of Diseases and Related Health Problems, 10th revision codes. Trends in upper gastrointestinal bleeding incidence, etiology, severity, associated Medicare reimbursements, and the impact of ppASA on bleeding outcomes were assessed with regression models.
RESULTS
From 2016-2020, adjusted incidence of upper gastrointestinal bleeding increased 29.2% among ppASA users, with larger increases for older patients (increase of 41.6% for age 65-74 years and 36.0% for age ≥75 years). The most common etiology among ppASA users was ulcer disease but increases in bleeding incidence due to angiodysplasias were observed. The proportion of hospitalizations with major complications or comorbidities increased 41.5%, and Medicare reimbursements increased 67.6%. Among patients without cardiovascular disease, ppASA was associated with increased odds of hospital admission, red blood cell transfusion, and endoscopic intervention as compared to no ppASA use.
CONCLUSIONS
Considering recent guideline recommendations, the rising incidence, severity, and costs associated with upper gastrointestinal bleeding among patients on ppASA highlights the importance of careful assessment for appropriate ppASA use.
背景
最近的指南不建议将阿司匹林常规用于一级心血管预防（ppASA），并建议由于出血风险而避免在老年人中使用 ppASA。然而，ppASA 经常被滥用于无适当适应证的情况。美国缺乏关于 ppASA 导致上消化道出血的发病率估计。在这项研究中，我们提供了 2016-2020 年期间使用 ppASA 的患者发生上消化道出血的发病率、特征和费用的全国估计数。
方法
使用国际疾病分类和相关健康问题第十次修订版代码，从全国急诊部样本中确定了出现上消化道出血的一级心血管预防使用者（长期服用阿司匹林但无心血管疾病的患者）。使用回归模型评估上消化道出血发病率、病因、严重程度、与医疗保险报销相关的趋势以及 ppASA 对出血结局的影响。
结果
从 2016 年至 2020 年，ppASA 使用者的上消化道出血调整发病率增加了 29.2%，老年患者的增幅更大（65-74 岁年龄组增加 41.6%，≥75 岁年龄组增加 36.0%）。ppASA 使用者中最常见的病因是溃疡病，但观察到由于血管发育不良导致的出血发病率增加。伴有主要并发症或合并症的住院比例增加了 41.5%，医疗保险报销增加了 67.6%。在无心血管疾病的患者中，与不使用 ppASA 相比，ppASA 与住院、红细胞输注和内镜介入的可能性增加相关。
结论
鉴于最近的指南建议，考虑到患者使用 ppASA 导致上消化道出血的发病率、严重程度和费用不断上升，强调了仔细评估适当使用 ppASA 的重要性。
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