West Suffolk NHS Foundation Trust, Bury Saint Edmunds, England, UK.
F1000Res. 2024 Jun 4;13:569. doi: 10.12688/f1000research.149548.1. eCollection 2024.
Rectal bleeding commonly occurs in elderly patients using blood thinners, posing management challenges due to limited guidance on reversal agents and medication restart criteria. This study aims to review the demographics and management of elderly patients with rectal bleeding while on blood thinners.
A retrospective analysis of patients aged 60 or older presenting with rectal bleeding at West Suffolk Hospital's emergency department was conducted from January 2018 to December 2020. Data were extracted from electronic records, focusing on patients using blood thinners and adhering to British Society of Gastroenterology guidelines. All patients ceased blood-thinning medications upon admission. The hospital's ethics committee approved the study, which focused on demographics, diagnosis, and management, particularly regarding re-initiation of blood-thinning medicines.
During the study period, 170 patients were admitted to the emergency department of West Suffolk Hospital. 93 (54.71%) patients were included in the study. The average age of the participants was 82 years, and 62.3% were male. All patients were followed up for three months. Atrial fibrillation accounted for 52% of patients, while previous strokes accounted for 20%. The most typical pathology was diverticulosis.Regarding restarting of anticoagulants, Among patients on DOAC (Direct oral anticoagulant), 39% were restarted on discharge, 23% were switched to warfarin, and another 23% were not restarted; 15% planned to restart after seven days. For those on Warfarin, 62% were restarted on discharge, 22% stopped the medication, and the rest were switched to Dual Oral Anticoagulant. Among aspirin patients, 60% were restarted at discharge, while the remaining discontinued. All patients receiving clopidogrel and dual antiplatelet therapy were started at discharge. None of the patients were readmitted during the follow-up period of 3 months.
Restarting of blood-thinning drugs in patients with rectal bleeding is subject to individual patient variation. Necessitates more extensive trials to achieve greater standardization.
在使用血液稀释剂的老年患者中，经常会出现直肠出血，由于缺乏逆转剂和药物重新开始使用标准的指导，给治疗管理带来了挑战。本研究旨在回顾在使用血液稀释剂的老年患者出现直肠出血时的人口统计学特征和治疗管理方法。
对 2018 年 1 月至 2020 年 12 月期间在萨福克西部医院急诊科就诊的年龄在 60 岁及以上的直肠出血患者进行了回顾性分析。从电子病历中提取数据，重点关注使用血液稀释剂且符合英国胃肠病学会指南的患者。所有患者入院后停止使用血液稀释药物。医院伦理委员会批准了这项研究，该研究主要关注人口统计学特征、诊断和治疗管理，特别是关于重新开始使用血液稀释药物的问题。
在研究期间，共有 170 名患者被收入萨福克西部医院急诊科，其中 93 名（54.71%）患者纳入研究。参与者的平均年龄为 82 岁，62.3%为男性。所有患者均随访 3 个月。房颤占患者的 52%，而既往卒中占 20%。最典型的病理是憩室病。关于重新开始使用抗凝药物，在使用 DOAC（直接口服抗凝剂）的患者中，39%在出院时重新开始使用，23%被转换为华法林，另有 23%未重新开始使用；15%计划在 7 天后重新开始。对于使用华法林的患者，62%在出院时重新开始使用，22%停止用药，其余的则转换为双重口服抗凝剂。在使用阿司匹林的患者中，60%在出院时重新开始使用，其余的则停止用药。所有接受氯吡格雷和双重抗血小板治疗的患者在出院时开始用药。在 3 个月的随访期间，没有患者再次入院。
在出现直肠出血的患者中重新开始使用血液稀释药物因个体患者的差异而有所不同，需要进行更广泛的试验以实现更大的标准化。
