小剂量阿司匹林亦可增加上消化道出血风险

2011-03-25 MedSci原创 MedSci原创

  西班牙学者研究发现,小剂量阿司匹林(ASA)可使上消化道出血(UGIB)风险几乎升高2倍,且当与氯吡格雷、口服抗凝药、非类固醇类抗炎药(NSAID)或大剂量口服皮质类固醇同时给药时,可进一步升高UGIB风险。研究发表于《循环》 [Circulation 2011, 123(10): 1108]杂志。   研究纳入2049例40~84岁的UGIB患者与2万例对照者

  西班牙学者研究发现,小剂量阿司匹林(ASA)可使上消化道出血(UGIB)风险几乎升高2倍,且当与氯吡格雷、口服抗凝药、非类固醇类抗炎药(NSAID)或大剂量口服皮质类固醇同时给药时,可进一步升高UGIB风险。研究发表于《循环》 [Circulation 2011, 123(10): 1108]杂志。

  研究纳入2049例40~84岁的UGIB患者与2万例对照者。结果显示,与未服药患者相比,服用小剂量ASA或氯吡格雷的患者UGIB风险升高[相对风险比(RR)分别为1.80和1.67]。与仅服用小剂量ASA相比,小剂量ASA与氯吡格雷、口服抗凝药、小或中等剂量NSAID、大剂量 NSAID或大剂量口服皮质类固醇同时服用升高UGIB风险(RR分别为2.08、2.00、2.63、2.66和4.43);与他汀类药物或小剂量口服皮质类固醇同时服用不升高UGIB风险。

  作者认为该研究结果只能为临床治疗提供参考。医生仍须考虑患者的基线风险及可能获益情况。研究结果发现,同时给予小剂量ASA和大剂量皮质类固醇升高UGIB风险幅度较大,提示临床应谨慎处方此种联合用药。氯吡格雷、华法林、NSAID升高UGIB风险已被广泛认知,但类固醇类药物此种风险并非众所周知。此外,指南及临床医生常未考虑各类患者UGIB风险有所不同,如老年和有消化性溃疡病史的患者此风险较高。为降低UGIB风险,作者认为临床可考虑撤药、减小药物剂量或给予质子泵抑制剂(PPI)进行保护。

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    2011-05-12 pyaili
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