Gastrointestinal sistem kanamalarında yeni kuşak oral antikoagülan ilaçların yeri

Year 2016, Volume: 24 Issue: 2, 29 - 35, 31.08.2016

Sema Kaymaz Tahra Yaşar Çolak Ebubekir Şenateş Miraç Vural Keskinler Hakan Dursun İlyas Tuncer Aytekin Oğuz

https://doi.org/10.17940/endoskopi.328228

Abstract

Giriş ve Amaç: Yeni oral antikoagülanların kullanıma girdiği bu ilk yıllarda herhangi bir antikoagülan ve/veya antiagregan kullanmakta iken gastrointestinal kanama sebebiyle hastanemize başvuran ve gastrointestinal sistem kanaması tanısıyla yatırılan hastalarda gastrointestinal sistem kanama sebepleri arasında yeni oral antikoagülanların yerini belirlemek ve ilaç grupları ile kanama ciddiyeti ve klinik tablo arasındaki ilişkilerin değerlendirilmesidir. Gereç ve Yöntem: Bu retrospektif çalışmaya antikoagülan ve/veya antiagregan kullanmakta iken gastrointestinal sistem kanama nedeniyle kliniğimize yatan toplam 178 hasta (ortalama yaş: 70±14 yaş) alındı. Hastalar yalnız antiagregan kullanan (n=124), yalnız antikoagülan kullanan (n=43) ve kombine ilaç kullanan (n=11) olarak üç ana gruba ayrıldı. Gruplar demografik veriler, biyokimyasal değerleri, 24 saatlik takip dilimlerinde maksimum hemoglobin düşüşleri, kan transfüzyonu miktarı ve mortalite oranlarına göre karşılaştırıldı. Bulgular: Hastaların ilaç kullanımına göre dağılımı; %70’inin antiagregan ilaç, %20’sinin varfarin, %4’ünün yeni oral antikoagülan, %6’sının kombine ilaç kullanımı şeklinde idi. Antiagregan ilaç grubunda %75 oranında aspirin kullanımı vardı. Antikoagülana bağlı kanamalarda ise varfarin %84, yeni oral antikoagülan ilaçlar %16 oranında tespit edildi. Antiagregan, antikoagülan ve kombine ilaç kullanım grupları arasında mortalite oranı (p=0.50), transfüzyon miktarı (p=0.72) ve maksimum hemoglobin düşüşleri (p=0.39) arasında fark saptanmadı. Yeni oral antikoagülanlar ile varfarin arasında morbidite ve mortalite oranlarında farklılık saptanmadı. Sonuç: Sonuç olarak yeni oral antikoagülanlar, antikoagülan ve/veya antiagregan kullanımı sonrası gastrointestinal kanama nedenleri arasında yer almaya başlamıştır. Varfarin ve yeni oral antikoagülanlarla ilişkili kanamaya bağlı morbidite ve mortalite oranları arasında anlamlı fark saptanmamıştır ancak bu ilaçların önümüzdeki yıllarda daha yaygın kullanımı ile gastrointestinal kanama etiyolojisindeki yerinin daha da artabileceği göz önüne alınmalıdır

Keywords

Antikoagülan, antiagregan, gastrointestinal kanama, yeni kuşak oral antikoagülan

The implication of new oral anticoagulant agents in gastrointestinal bleeding

Abstract

Background and Aims: This study was designed to (i) address the position of new oral anticoagulants in the etiology of bleeding in patients admitted to our hospital for gastrointestinal bleeding while using any anticoagulant and/ or any antiaggregant drug and (ii) assess the relationships between the drug groups and severity of bleeding and the clinical picture in the first years of new oral anticoagulant use. Material and Methods: A total of 178 patients (mean age: 70±14 years) who were admitted to our clinic for gastrointestinal bleeding while using an anticoagulant and/or antiaggregant agent were recruited retrospectively. Patients were divided into the following three primary categories: patients using antiaggregant drugs (n=124), anticoagulant drugs (n=43), and both (n=11). The groups were compared according to their demographic data, biochemical parameters, 24-h follow-up period, maximum decrease in hemoglobin levels, amount of blood transfused, and mortality rates. Results: A total of 70% of the patients were taking antiaggregant drugs, 20% were using warfarin, 4% were taking new oral anticoagulants, and 6% of them were taking a combination of anticoagulants and antiaggregants. A total of 75% of the patients were using aspirin, 84% were taking warfarin, and 16% were taking new oral anticoagulants. There was no difference between the groups in terms of mortality rate (p=0.50), transfusion amount (p=0.72), and maximum hemoglobin decrease (p=0.39). There was also no difference in morbidity and mortality rates between patients taking new oral anticoagulants and those taking warfarin. Conclusion: Use of new oral anticoagulants has been listed as a cause for gastrointestinal bleeding. Although there was no difference between warfarin and new oral anticoagulant treatment with regard to mortality and morbidity rates, with the increasing use of these drugs in the forthcoming years, augmentation of their position in gastrointestinal bleeding etiology should be considered.

Keywords

Anticoagulant, antiaggregant, gastrointestinal bleeding, new oral anticoagulants

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