冠脉介入术患者经双联抗血小板治疗发生消化道出血返院治疗的临床特点

    Clinical Characteristics of Patients Hospitalized Again with Gastrointestinal Bleeding and Receiving Dual Antiplatelet Treatment after PCI

    • 摘要: 目的 探讨经皮冠脉介入术患者使用双联抗血小板治疗后因消化道出血返院诊治的临床特点。 方法 选取2011-2013年在广东省人民医院心内科行冠脉介入术长期双联抗血小板治疗后再次住院的患者2 675例,收集了其中28例疑似消化道出血患者的临床资料,对于其中21例确诊为消化道出血的患者使用CRUSADE出血评分系统进行出血风险危险分层,分析该21例患者消化道出血诊治的相关临床特点。 结果 21例确诊消化道出血患者中,高龄患者(>60岁)14例(66.7%),男性16例(76.2%),吸烟史患者5例(23.8%),消化性溃疡病史5例(23.8%),消化道出血病史2例(9.5%),肾功能不全病史17例(81%),心功能衰竭病史18例(85.7%),幽门螺杆菌感染7例(33.3%)。使用CRUSADE出血评分系统进行出血风险评分并行危险分层,其中出血风险极高危者7例(33.3%),高危者5例(23.8%),中危者6例(28.6%)。消化道出血前曾预防性口服质子泵抑制剂6例,消化道出血后所有患者均使用质子泵抑制剂治疗。本组患者有一半以上(61.9%)在消化道出血后停用了所有抗血小板治疗药物,消化道出血控制后,约一半(52.4%)患者使用氯吡格雷继续抗血小板治疗。 结论 CRUSADE评分系统可以用于经皮冠脉介入术后双联抗血小板治疗患者消化道出血风险的早期评估。抗血小板药物的停用与重新使用应根据消化道出血的严重程度、支架血栓形成的风险等综合评估。

       

      Abstract: Objective To explore clinical characteristics in patients suffering gastrointestinal bleeding and receiving double anti-platelet therapy (DAPT) after percutaneous coronary intervention. Methods We have screened 2 675 patients hospitalized again receiving dual antiplatelet treatment after percutaneous coronary intervention at Guangdong General Hospital, between 2011 and 2013. Overall, the data from 28 patients with suspected gastrointestinal bleeding were collected. And 21 patients were diagnosed with gastrointestinal bleeding. Baseline risks of major bleeding in these 21 patients were assessed by using CRUSADE bleeding score system and the clinical features were analyzed retrospectively. Results There have been 21 confirmed cases, including 14(66.7%) aged patients (over 60 year age), 16(76.2%) male patients, 5(23.8%) patients with smoking history, 5(23.8%) patients with peptic ulcer history, 2(9.5%) patients with gastrointestinal bleeding history, 17(81%) patients with renal insufficiency history, 18(85.7%) patients with heart failure history, 7(33.3%)patients with Helicobacter pylori infection history. Using CRUSADE bleeding score system to assess baseline risk of major bleeding in these 21 patients, 7(33.3%) cases were at very high risk of major bleeding, 5(23.8%) cases at high risk of major bleeding, and 6(28.6%) cases at moderate risk of major bleeding. Among these patients, there were 6 patients with prophylactic use of proton pump inhibitors (PPIs). PPIs were used in all patients after gastrointestinal bleeding. In this group, more than half (61.9%) were discontinued with all the anti-platelet therapy, and about half (52.4%) were given Clopidogrel only after gastrointestinal bleeding. Conclusion Risk stratification of gastrointestinal bleeding can be made early in patients receiving dual antiplatelet treatment after PCI through using CRUSADE bleeding score system. The use of anti-platelet therapy should be in the light of comprehensive evaluation of the severity of the bleeding and the risk of stent thrombosis once gastrointestinal bleeding occurred.

       

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