| Objective:Analyze the relationship between gastrointestinal tract injury and oral anti-thrombotic drugs (anti-platelet and anticoagulant drugs) for patients with Coronary Heart Disease (CHD); Investigate and assess relative factors and current treatment effect on the digestive tract damage after patients with CHD use oral anti-platelet and anticoagulant drugs; Explore and guide the feasibility of reducing adverse reaction of anti-thrombotic drugs to digestive tract.Methods:Adopt retrospective research method and collect the clinical data of604patients with CHD using anti-thrombotic drugs in our hospital from January2012to December2013in order to make analysis of digestive tract damage, assess the application of clinical commonly used oral anti-thrombotic drugs (aspirin, clopidogrel, and warfarin), and analyze the impact factors on patients with digestive tract injury.This study is classified as follows according to the influential factors:infected group with oral anti-thrombotic drugs combined with HPand infected group with unincorporated HP;the group with combined use of acid-suppression drugs and/or gastric mucosa protectant and the group not using; according to the age in young and middle-aged groups (≤65), the elderly group(65-75),the older elderly group (>75);the group with combination of smoking and alcoholism history and the group with unincorporated of alcoholism and smoking history; group with only using anti-thrombotic drug(including aspirin group, clopidogrel group and warfarin group) andcombined anti-thrombotic drugsgroup (including aspirin+clopidogrel group, aspirin+warfaringroup,aspirin+clopidogrel+warfaringroup), group with using aspirinplain radiographs and group with using aspirin enteric-coated tablets.Patients with digestive tract damage in case this study include:there are symptoms such as nausea, vomiting, epi-gastric discomfort, hematemesis, black and/or defecate occult blood positive cases, the merger of chronic gastritis, gastric ulcer, duodenal ulcer and gastrointestinal bleeding, gastro-esophageal re-flux disease are in the group.Patients with digestive tract damage in case will be included in this study:there are symptoms such as nausea, vomiting, gastric discomfort, hematemesis and melena and/or positive stool occult blood. In addition,patients with the merger of chronic gastritis, gastric ulcer, duodenal ulcer and gastrointestinal bleeding, gastro-esophageal re-flux disease can be divided into in the group.Results:1. Among CHD patients taking oral anti-thrombotic therapy, patients withgastrointestinal tract injury and HP accounts45.1%; the digestive tract injury without HP infection29.9%, which is statistically significant to warn patients using oral anti-thrombotic drugs that the HP infection will aggravate digestive tract damage(P<0.01).2. In this study, there has been a serious shortage of appliedacid-suppressing drugs (H2receptor antagonists, proton pump inhibitors) and gastric mucosal protective agent proportion, only27.8%. Gastrointestinal injury rate inunapplied group reaches40.2%. By comparison, the digestive tract injury rate in applied group is8.93%. Gastrointestinal injury rate is decreased obviously after using acid-suppressing drugs and gastric mucosal protective agent(P<0.05), which is statistically significant to confirm that the acid-suppressing drugs and gastric mucosal protective agent can effectively reduce the digestive tract damage caused by anti-thrombotic drugs.3. In this study,392elderly people more than65years old accounting for64.9%,42.1%of the digestive tract injury rate;212young and middle-aged people less than or equal to65years old accounting for35.1%of the group,15.6%of the digestive tract injury rate. The proportion of elderly patients with digestive tract injury is significantly higher than that of the middle-aged and young patients, statistically as an independent risk factor(P<0.05).4. Statistical data from studying the connection between patients with bad habits such as smoking, drinking and digestive tract injury show that there are172cases with history of smoking and alcoholism (86.9%) in gastrointestinal injury group,26cases (13.1%) without history of smoking and alcoholism and326cases (80.3%) with history of smoking and alcoholism in group without gastrointestinal injury,80cases (19.7%) without history of smoking and alcoholism, whose differences between the two groups are statistically significant (P<0.05).5. There is difference suffering from the digestive tract injury (P<0.05) between the group using a kind of drug and the group using combined drugs. It is concluded that the combined use of drug can makedigestive tractdamage obviously increasedwith statistical significance. The combination of aspirin+clopidogrel+warfarin will cause more damage to digestive tract. And the use of three kinds of drugs compared with two kinds of drugs has higher risk injuring the digestive tract.6. Patients with oral aspirin in this study accounts for31.3%; Patients with oral aspirin enteric-coated tablets accounts for68.7%. In our hospital patients with coronary heart disease usemore aspirin enteric-coated tablets than aspirin flat tabletsin clinical application.But according to our group it showed that32patients using aspirin flat suffering from gastrointestinal injury in the groupaccounts for32.7%of group taking oral aspirin flat tablets;68patients using aspirin enteric-coated suffering from gastrointestinal injury in the group accounts for31.6%) of group taking oral enteric-coated tablets. There are little differencecompared with the group using aspirin flat tablets, insignificant in statistics(P>0.05).Conclusion:1. The digestive tract damage caused by anti-thrombotic drugs is closely associated with helicobacter pylori.Clinicians, while giving patients anti-thrombotic drug treatment at the same time, should fully consider the possibility of aggravating digestive tract injury by helicobacter pylori infection, and give proper detection methods. If it is positive, apply any anti-thrombotic therapyafter the h. pylori iscleared away 2. Acid-suppressing drugs (H2receptor antagonists, proton pump inhibitors) and gastrointestinal mucous membrane protective agent can effectively reduce the digestive tract damage caused by anti-thrombotic drugs and patients with coronary heart disease taking anti-thrombotic therapy should also use acid-suppressing drugs and gastrointestinal mucousprotestant in early time.3. The rate of gastrointestinal injury caused by anti-thrombotic treatment increases for the elderly over the age of65. Risk increased significantly in particular for patients with a history of gastrointestinal bleeding, ulcers, dyspepsia and gastro-esophageal. Bad habits, such as smoking, alcohol can aggravate digestive system damage ales.4. The risk of digestive track damage increases as the growth of anti-thrombotic drugs’ varieties and numbers. As a result, combined anti-thrombotic treatment for high-risk patients with digestive tract damage should be avoided as much as possible. The time of using anti-thrombotic drugs should be reasonably controlled in order to reduce the risks of gastrointestinal injury. In addition, the time of long-term combined use of anti-thrombotic drugs should be reduced. Aspirin plain tablets and enteric-coated tablets in gastrointestinal injury have no obvious differences. |
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