Objective To investigate risk factors of upper gastrointestinal bleeding caused by dual antiplatelet therapy(DAPT) after percutaneous coronary intervention(PCI).Methods Totally 1263 patients who had underwent PCI from January 2012 to July 2012 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.All patients were given aspirin enteric-coated tablets(100mg/time,1 time/d)and clopidogrel sulfate tablets (75mg/time,1 time/d).The postoperative follow-up lasted for 6 months.Gender;age;histories of hypertension,diabetes mellitus,thrombotic disease,heart failure,gastrointestinal bleeding,smoking,drinking;family history of digestive tract disease;postoperative application of heparin;heart rate;systolic blood pressure;CRUSADE bleeding score;Killip classification of cardiac function;preoperative values of hemoglobin concentration,hematocrit,platelet concentration,creatinine clearance rate,platelet aggregation rate and fasting blood glucose were recorded.Occurrences of upper gastrointestinal bleeding were observed.Multivariate logistic regression was used to analyze risk factors of upper gastrointestinal bleeding caused by DAPT after PCI.Results Totally 52 cases (4.1％)had upper gastrointestinal bleeding.Gender[odds ratio(OR):0.323,95％ confidence interval (CI):0.130-0.802];age(OR:1.026,95％ CI:0.990-1.063);history of thrombotic disease(OR:2.522,95％ CI:1.093-5.820);history of gastrointestinal bleeding(OR:8.704,95％ CI:3.292-23.012);family history of digestive tract disease (OR:2.253,95％ CI:1.147-4.426);postoperative application of heparin (OR:0.323,95％ CI:0.174-0.606);heart rate (OR:1.038,95％ CI:1.004-1.074);CRUSADE bleeding score (OR:1.775,95％ CI:1.141-2.764);Killip classification of cardiac function(OR:1.700,95％ CI:1.011-2.857);preoperative hemoglobin concentration(OR:0.911,95％ CI:0.872-0.952),hematocrit(OR:1.397,95％ CI:120-1.627),creatinine clearance rate(OR:0.988,95％ CI:0.977-1.000),platelet aggregation rate (OR:0.957,95 ％ CI:0.941-0.973) and fasting blood glucose (OR:121.1,95 ％ CI:1.078-136) were risk factors of upper gastrointestinal bleeding caused by DAPT after PCI (P ＜ 0.05 or P ＜ 0.01).Conclusion Male;advanced age;history of thrombotic disease;history of gastrointestinal bleeding;family history of digestive tract disease;postoperative application of heparin;rapid heart rate;high CRUSADE score;high Killip classification of cardiac function;low levels of preoperative hemoglobin concentration,hematocrit,creatinine clearance rate,platelet aggregation rate and high level of fasting blood glucose are risk factors of upper gastrointestinal bleeding in patients treated by DAPT after PCI.%目的 探讨经皮冠状动脉介入治疗(PCI)术后双联抗血小板治疗(DAPT)所致上消化道出血的危险因素.方法 回顾性分析2012年1-7月于首都医科大学附属北京安贞医院择期行PCI手术的患者1263例,术后均口服阿司匹林肠溶片(100mg/次,1次/d)和硫酸氢氯吡格雷片(75mg/次,1次/d).PCI术后随访6个月,记录患者的临床资料,包括性别、年龄、高血压病史、糖尿病病史、血栓性疾病病史、心力衰竭病史、消化道出血病史、吸烟史、饮酒史、消化道疾病家族史、术后是否应用肝素、心率、收缩压、CRUSADE出血评分危险级别、心功能Killip分级,以及术前血红蛋白浓度、血细胞比容、血小板浓度、肌酐清除率、血小板最大聚集率和空腹血糖值,共21项;记录上消化道出血发生情况.采用多因素Logistic回归分析PCI术后DAPT患者发生上消化道出血的危险因素.结果 1263例患者中有52例患者发生上消化道出血,发生率为4.1％.患者的性别(比值比:0.323,95％置信区间:0.130 ～0.802),年龄(比值比:1.026,95％置信区间:0.990 ～ 1.063),血栓性疾病病史(比值比:2.522,95％置信区间:1.093 ～5.820),消化道出血病史(比值比:8.704,95％置信区间:3.292 ～23.012),消化道疾病家族史(比值比:2.253,95％置信区间:1.147 ～4.426),术后是否应用肝素(比值比:0.323,95％置信区间:0.174～ 0.602),心率(比值比:1.038,95％置信区间:1.004 ～1.074),CRUSADE出血评分危险级别(比值比:1.775,95％置信区间:1.141～2.764),心功能Killip分级(比值比:1.700,95％置信区间:1.011～2.857),术前血红蛋白浓度(比值比:0.911,95％置信区间:0.872 ～0.952)、血细胞比容(比值比:1.397,95％置信区间:1.200～ 1.627)、肌酐清除率(比值比:0.988,95％置信区间:0.977 ～ 1.000)、血小板最大聚集率(比值比:0.957,95％置信区间:0.941 ～0.973)、空腹血糖值(比值比:1.211,95％置信区间:1.078 ～1.360)是PCI术后DAPT患者发生上消化道出血的危险因素(P＜0.05或P＜0.01).结论 男性,高龄,有血栓性疾病病史,有消化道出血病史,有消化道疾病家族史,术后应用肝素,心率快,CRUSADE出血评分危险级别、心功能Killip分级高,术前血红蛋白浓度、血细胞比容、肌酐清除率、血小板最大聚集率低,术前空腹血糖高是PCI术后DAPT患者发生上消化道出血的危险因素,临床上若合并上述情况,应引起重视并及时给予相应治疗,以减少上消化道出血的发生.
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