Eur Heart J:MI后接受DAPT的患者采用PPI治疗可使胃肠道出血风险降低

2019-03-10 xing.T 网络

由此可见,质子泵抑制剂治疗的使用程度低于MI后接受DAPT治疗的指南原则,并且通常与降低UGI出血风险有关。考虑到总体出血风险较低,应更多地关注确定从PPI治疗中获益最多的患者。

对于接受双重抗血小板治疗(DAPT)治疗的患者,他们对预防肠道出血的治疗建议有所不同。近日,血管领域权威杂志Eur Heart J上发表了一篇研究文章,研究人员试图分析质子泵抑制剂(PPIs)预防DAPT治疗的心肌梗死(MI)患者上肠道(UGI)出血的有效性,这与当前的欧洲心脏病学会指南建议相关。

研究人员链接到丹麦全国登记处,以确定出院后7天因急性心肌梗死而接受DAPT治疗的患者,并将抗生素治疗的患者排除在外。研究人员使用多重Cox回归建模来计算与PPI使用相关的UGI出血的平均风险。根据指南风险评估比较相关的治疗效果。

研究人员分析46301例心肌梗死后接受DAPT治疗的患者。根据指南标准,只有35%的UGI出血风险较高的患者接受了PPI治疗。对于高危患者,1年的UGI出血风险为1.0%[95%可信区间(CI)为0.9-1.1%]和1.7%(CI为1.5-2.0%)。与未治疗相比,总体PPI与UGI出血风险比为0.62(CI为0.48-0.77),相对应的绝对风险差异为0.44%(CI为0.39-0.48%)。对于高危患者,质子泵抑制剂治疗与类似的绝对风险差异相关[0.47%(CI为0.43-0.51%)]。

由此可见,质子泵抑制剂治疗的使用程度低于MI后接受DAPT治疗的指南原则,并且通常与降低UGI出血风险有关。考虑到总体出血风险较低,应更多地关注确定从PPI治疗中获益最多的患者。

原始出处:

Thomas S G Sehested.et al.Reduced risk of gastrointestinal bleeding associated with proton pump inhibitor therapy in patients treated with dual antiplatelet therapy after myocardial infarction.Eur Heart J.https://doi.org/10.1093/eurheartj/ehz104

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    2019-03-12 zhaojie88
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    2019-03-12 mnda
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    2019-03-12 slcumt

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