PCI术后抗血小板联合抗凝治疗患者消化道出血危险因素及治疗策略分析

Analysis of Risk Factors and Therapeutic Strategies for Gastrointestinal Bleeding Following PCI in a Patient Who was Given Antiplatelet Agents and Anticoagulants

关键词:  经皮冠脉介入术  抗血小板药物  阿司匹林  氯吡格雷  华法林  胃肠出血

Key words:  percutaneous coronary intervention  antiplatelet agents  aspirin  clopidogrel  warfarin  gastrointestinal bleeding

摘要:

目的 分析抗血小板及抗凝药物致消化道出血的危险因素及治疗策略。方法 临床药师参与1例消化道出血患者的治疗过程，从具体案例着手，结合患者病情进行系统分析。结果 双联抗血小板、华法林、未系统监测INR、高龄、未预防性使用质子泵抑制剂等引起患者慢性消化道出血加重，通过对症止血、补血处理及停用抗血小板及抗凝药物，患者出血症状得到有效控制。结论 对于消化道出血高危人群，应及时加用质子泵抑制剂至少3个月预防治疗。新型胃黏膜保护剂如瑞巴匹特等对抗血小板药物导致的消化道损伤亦有显著的预防作用，可考虑作为质子泵抑制剂的替代治疗。

Abstract:

OBJECTIVE To analyze risk factors and therapeutic strategies for gastrointestinal bleeding during the treatment of antiplatelet agents and anti-coagulants. METHODS Clinical pharmacists made a systermatic analysis through a specific case. RESULTS Dual anti-platelet, warfarin, irregular INR-testing, elder, lost preventive using of pump inhibitors, which were all the reasons to result in gastrointestinal bleeding. The patient's bleeding symptoms had an effective control vias hemostatic, transfusions and the stopping using of antiplatelet agents and anticoagulants. CONCLUSION For people at high risk of gastrointestinal bleeding, proton pump inhibitors should be given timely as a prevention stratagem at least 3 months. The new protective agent of gastric mucosa such as rebamipide is useful for the primary prevention of gastric mucosal injury and can be considered as an alternative in the treatment of proton pump inhibitors.