Bar-Dayan Y, Levy Y, Amital H, Shoenfeld Y
Department of Medicine 'B', Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.
Ann Med Interne (Paris). 1997;148(6):430-3.
The use of low dose aspirin is associated with upper gastrointestinal bleeding, especially in the elderly. Anemia is one of the risk factors of acute myocardial infarction especially in patients with ischemic heart disease.
We present a series of fifteen patients treated with low dose aspirin for secondary prevention of ischemic heart disease who had upper GI bleeding and were admitted to our hospital because of unstable angina or myocardial infarction. Nine patients had acute myocardial infarction and six patients had unstable angina. The mean age of the patient was 72 +/- 9 years. Only two patients had a previous history of duodenal ulcer before their admission. The duration of aspirin therapy ranged from a few days to more than a year. Weakness, abdominal pain and melena were present in most of the patients between 2-7 days before the appearance of chest pain, and syncope was the chief complaint in 5 patients.
We conclude that aspirin which is given to patients in order to prevent myocardial infarction might cause myocardial infarction as a sequella of upper gastrointestinal bleeding. Lack of patient education was the primary cause of the delayed diagnosis of this complication. Instruction of patients treated by aspirin to seek medical advise because of symptoms of gastrointestinal bleeding could prevent acute myocardial infarction in patients treated by aspirin who have upper gastrointestinal bleeding.
低剂量阿司匹林的使用与上消化道出血有关，尤其是在老年人中。贫血是急性心肌梗死的危险因素之一，特别是在患有缺血性心脏病的患者中。
我们报告了一系列15例因缺血性心脏病二级预防而接受低剂量阿司匹林治疗的患者，他们发生了上消化道出血，并因不稳定型心绞痛或心肌梗死入院。9例患者发生急性心肌梗死，6例患者发生不稳定型心绞痛。患者的平均年龄为72±9岁。入院前只有2例患者有十二指肠溃疡病史。阿司匹林治疗的持续时间从几天到一年多不等。大多数患者在胸痛出现前2至7天出现乏力、腹痛和黑便，5例患者以晕厥为主要症状。
我们得出结论，给予患者用于预防心肌梗死的阿司匹林可能会因上消化道出血的后遗症而导致心肌梗死。患者教育不足是该并发症延迟诊断的主要原因。指导服用阿司匹林的患者因胃肠道出血症状寻求医疗建议，可以预防服用阿司匹林且有上消化道出血的患者发生急性心肌梗死。
