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Chảy máu tiêu hóa do thuốc gây ra
Tóm tắt
Chảy máu tiêu hóa là một sự kiện thường gặp và có thể đe dọa tính mạng, đặc biệt là ở người cao tuổi. Nguyên nhân chủ yếu thường do thuốc gây ra. Các loại thuốc có thể dẫn đến chảy máu tiêu hóa bao gồm chủ yếu là thuốc chống viêm không steroid như Diclofenac hoặc Ibuprofen, thuốc ức chế kết tập tiểu cầu như Acetylsalicylsäure, Clopidogrel hoặc Prasugrel, và các thuốc chống đông như các đối kháng vitamin K, Heparin hoặc các thuốc chống đông đường uống trực tiếp. Điều trị phối hợp, chẳng hạn như ức chế tiểu cầu kép hoặc sự kết hợp giữa ức chế kết tập tiểu cầu với chống đông, đi kèm với nguy cơ chảy máu cao hơn so với điều trị đơn thuần. Có các phương pháp dự phòng sơ cấp và thứ cấp như triệt tiêu Helicobacter pylori hoặc dùng thuốc hỗ trợ với thuốc ức chế bơm proton.
Từ khóa
#chảy máu tiêu hóa #thuốc #người cao tuổi #chống viêm không steroid #ức chế kết tập tiểu cầu #chống đôngTài liệu tham khảo
Rollhauser C, Fleischer DE (2004) Nonvariceal upper gastrointestinal bleeding. Endoscopy 36:52–58
Ohmann C, Imhof M, Ruppert C et al (2005) Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 40:914–920
Crooks CJ, West J, Card TR (2013) Comorbidities affect risk of nonvariceal upper gastro-intestinal bleeding. Baillieres Clin Gastroenterol 144:1384–1393
Lanas Á et al (2015) Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol 13:906–912
Götz M, Anders M, Biecker E et al (2017) S2k-Leitlinie Gastrointestinale Blutung. Z Gastroenterol 55:883–936
Salvo F, Fourrier-Reglat A, Bazin F et al (2011) Cardiovascular and gastrointestinal safety of NSAIDs: a systematic review of meta-analyses of randomized clinical trials. Clin Pharmacol Ther 89(6):855–866
Huang JQ, Sridhar S, Hunt RH (2002) Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet 539:14–22
Silverstein FE, Faich G, Goldstein JL (2000) Gastrointestinal toxicity with celecoxib vs nonsteroidal antiinflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. JAMA 284:1247–1255
Emery P, Zeidler H, Kvien TK et al (1999) Celecoxib versus diclofenac in long-term management of rheumatoid arthritis: a randomised double-blind comparison. Lancet 354:2106–2111
Niculescu L, Huang J, Mallen S (2009) Pooled analysis of GI tolerability of 21 randomized controlled trials of celecoxib and nonselective NSAIDs. Curr Med Res Opin 25:729–740
Baraf HSB, Fuentealba C, Greenwald M et al (2007) Gastrointestinal side effects of etoricoxib in patiens with osteoarthritis: results oft he Etoricoxib versus Diclofenac Sodium Gastrointestinal Tolerability and Effectiveness (EDGE) trial. J Rheumatol 34:408–420
Goldstein JL, Eisen GM, Lewis B et al (2007) Small bowel mucosal injury is reduced in healthy subjects with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol Ther 25:1211–1222
Laine L, Smith R, Min K et al (2006) Systematic review: the lower gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 24:751–767
Chan FK, Hung LC, Suen BY et al (2002) Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med 347:2104–2110
Chan FK, Wong VW, Suen BY et al (2007) Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial. Lancet 369:1621–1626
Fischbach W, Malfertheiner P, Lynen P et al (2016) S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit. Z Gastroenterol 54:327–363
ACTIVE Investigators, Conolly SJ, Pogue J, Hart RG et al (2009) Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 360(20):2066–2078
Lanas A, Fuentes J, Benito R et al (2002) Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther 16:779–786
CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348:1329–1339
Serebruany VL, Malinin AI, Ferguson JJ et al (2008) Bleeding risks of combination vs. single antiplatelet therapy: a meta-analysis of 18 randomized trials comparing 129 314 patients. Fundam Clin Pharmacol 22:315–321
Wiviott SD, Braunwald E, McCabe CH et al (2007) Triton-TIMI-38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357(20):2001–2015
Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151
Hart RG, Benavente O, McBride R, Pearce LA (1999) Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 131:492–501
Conolly SJ, Eikelboom J, Joyner C et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364:806–817
Granger CB, Alexander JH, McMurray JJV et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365:981–992
Patel MR, Mahaffey KW, Garg J et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365:883–891
Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151
Holster L, Valkhoff VE, Kuipers EJ, Tjwa ETTL (2013) New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 145:105–112
Ruff CT, Giugiano RP, Braunwald E et al (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383:955–962
Li A, Garcia DA, Lyman GH, Carrier M (2018) Direct oral anticoagulant (DOAK) versus low-molecular-weight heparin (LMWH) for treatment of cancer associated thrombosis (CAT): a systematic review and meta-analysis. Thromb Res 173:158–163. https://doi.org/10.1016/j.thromres.2018.02.144
Chan FK, Lanas A, Scheiman J et al (2010) Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet 376:173–179
Hooper L, Brown TJ, Elliott R et al (2004) The effectiveness of five strategies fort he prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic review. BMJ 329:948
Denzer U, Beilenhoff U, Eickhoff A et al (2015) S2k-Leitlinie Qualitätsanforderungen in der gastrointestinalen Endoskopie, AWMF Register Nr. 021-022. Z Gastroenterol 53:E1–E227
Sung JJ, Lau JY, Ching JY et al (2010) Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 152:1–9
Sengupta N, Feuerstein JD, Patwardhan VR et al (2015) The risks of thromboembolism versus gastrointestinal bleeding after interruption of systemic anticoagulation in hospitalized inpatients with gastrointestinal bleeding: A prospective study. Am J Gastroenterol 110:328–335