医学免费论文:双重抗血小板治疗并发上消化道出血的风险及治疗

来源：本站原创更新：2013-9-27 论文投稿平台

上述资料提示对植入支架的患者应尽可能继续行抗血小板治疗，但要平衡支架内血栓形成和持续出血或再发出血之间的危险。支架内血栓的危害与支架位置、治疗血管供血区存活心肌数量等因素有关。而UGH患者再出血和死亡风险可通过临床表现和内镜检查结果来综合评估，即Rockall评分系统，<3分预后良好，>8分有较高的死亡率。随着治疗水平的提高，该评分系统可能轻度高估再出血风险[19]。对于近期(金属裸支架4周，药物涂层支架6个月)植入支架后出现严重上消化道出血的患者，建议停用肝素、比伐卢定等抗凝药及GPⅡb/Ⅲa受体拮抗剂，除非有进行性出血，一般不需要输注血小板。根据Rockall评分调整抗血小板治疗，积分≤4，中断抗血小板治疗的死亡风险大于UGH，继续行双重抗血小板治疗;积分≥5，继续口服氯吡格雷，停用阿司匹林48 h再评估，2周内加用阿司匹林治疗;持续出血者应停用所有抗血小板药物，每天评估出血状态，1～2周内加用氯吡格雷[3,23]。

5 总结

PCI术后患者接受双重抗血小板治疗，使上消化道黏膜损伤和出血的病例明显增加。治疗过程中有时中断抗血小板治疗，使得支架内血栓形成风险显著增加，加上严重消化道出血本身的风险，使得该类患者死亡率高。因此，治疗过程中要权衡支架内血栓和严重出血所带来的危险，但目前对此还存在许多分歧，仍需要进一步的随机临床试验来制定合理的治疗方案。

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