Greenberg P D, Cello J P, Rockey D C
San Francisco General Hospital, Department of Medicine, University of California 94110, USA.
Am J Med. 1996 Jun;100(6):598-604. doi: 10.1016/s0002-9343(96)00009-5.
To determine whether low-dose aspirin or warfarin induces fecal occult blood loss.
A prospective, cross-over study, of 100 participants over 40 years of age in 1 of 3 groups, taking: (1) no aspirin or warfarin, (2) daily aspirin (either 81 or 325 mg), or (3) warfarin, but no aspirin. Stool samples were collected and analyzed for the presence of occult blood using HemoQuant and Hemoccult II. After collection of baseline samples, patients initially taking no aspirin (group 1) were asked to take regular aspirin (325 mg daily) for 2 months. Patients initially taking aspirin 81 mg daily (group 2) were switched to 325 mg daily for 2 months, and vice versa.
Patients taking no aspirin had mean fecal blood of 0.68 +/- 0.05 mg hemoglobin/g stool, which increased to 1.41 +/- 0.36 mg/g after taking 325 mg of aspirin daily (P = 0.02). In contrast, patients in group 2, taking 81 mg and 325 mg of aspirin, had mean fecal blood of 0.82 +/- 0.08 mg/g (P = 0.57) and 1.04 +/- 0.23 mg/g (P = 0.13), respectively (comparisons with patients taking no aspirin). The mean blood loss in patients taking warfarin was 0.51 +/- 0.04 mg/g (P = 0.55), and fecal blood was not related to the degree of anticoagulation. There was no increase over normal in the rate of Hemoccult II-positive stool tests with aspirin or warfarin therapy.
Aspirin, but not warfarin, caused a small but clinically insignificant increase in occult fecal blood. The small blood loss in patients taking aspirin or warfarin is unlikely to interfere with fecal occult blood test. Therefore, positive fecal occult blood tests, in patients taking either low-dose aspirin or warfarin, should be managed in the same fashion as patients not taking these medications.
确定低剂量阿司匹林或华法林是否会导致粪便潜血。
一项前瞻性交叉研究，对100名40岁以上的参与者进行分组，分为3组中的1组，分别服用：（1）不服用阿司匹林或华法林；（2）每日服用阿司匹林（81毫克或325毫克）；（3）服用华法林，但不服用阿司匹林。收集粪便样本，使用HemoQuant和Hemoccult II分析潜血情况。在收集基线样本后，最初未服用阿司匹林的患者（第1组）被要求服用常规阿司匹林（每日325毫克），持续2个月。最初每日服用81毫克阿司匹林的患者（第2组）改为每日服用325毫克，持续2个月，反之亦然。
未服用阿司匹林的患者粪便平均血红蛋白含量为0.68±0.05毫克/克粪便，每日服用325毫克阿司匹林后增至1.41±0.36毫克/克（P = 0.02）。相比之下，第2组中分别服用81毫克和325毫克阿司匹林的患者，粪便平均血红蛋白含量分别为0.82±0.08毫克/克（P = 0.57）和1.04±0.23毫克/克（P = 0.13）（与未服用阿司匹林的患者相比）。服用华法林的患者平均失血量为0.51±0.04毫克/克（P = 0.55），粪便潜血与抗凝程度无关。使用阿司匹林或华法林治疗后，Hemoccult II阳性粪便检测率未超过正常水平。
阿司匹林而非华法林会导致粪便潜血出现小幅度但在临床上无显著意义的增加。服用阿司匹林或华法林的患者少量失血不太可能干扰粪便潜血检测。因此，服用低剂量阿司匹林或华法林的患者粪便潜血检测呈阳性时，应与未服用这些药物的患者以相同方式处理。
