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在肝移植患者的双重抗血小板治疗中,胃肠道出血的风险

Mark Cromer1, Kaitlyn Domning2, Rebecca Sullivan3

  • 1Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Prisma Health / University of South Carolina School of Medicine - Greenville, Greenville, South Carolina, USA.

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概括

双抗血小板治疗 (DAPT) 对于正在接受肝移植 (LT) 的代谢功能失调相关的脂肪肝炎 (MASH) 肝硬化患者是安全的. 在这个高危人群中,DAPT没有增加胃肠道出血或相关并发症的风险.

关键词:
肝硬化冠状动脉疾病双重抗血小板治疗胃肠道出血腹出血

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科学领域:

  • 肝病学
  • 心脏病学
  • 移植医学

背景情况:

  • 代谢功能障碍相关的脂肪肝硬化 (MASH) 是肝移植的主要原因,增加了心血管事件的风险.
  • 经过冠状动脉支架后接受LT评估的肝硬化患者需要双抗血小板治疗 (DAPT),但安全性数据有限.
  • 在肝硬化患者中,与DAPT相关的胃肠道出血和死亡风险尚未得到充分证实.

研究的目的:

  • 评估在LT评估期间接受DAPT的肝硬化患者的胃肠道出血的发生率和结果.
  • 确定DAPT在非补偿性肝硬化和冠状动脉疾病患者中的安全性.

主要方法:

  • 对于接受左心导管治疗的非补偿性肝硬化患者 (2014 - 2021 年) 的回顾性评估.
  • 在LHC后接受DAPT的患者与未接受DAPT的患者之间的结局比较.

主要成果:

  • 在DAPT (9. 09%) 和对照组 (14. 73%) 之间,肠道出血率没有显著差异 (p=0. 3808).
  • 两组之间发生的水出血率,12个月死亡率和长期出血率相似.
  • 多变量分析显示,DAPT的消化道出血率没有增加 (OR=0. 5789;95% CI=0. 1682-1. 9922;p=0. 3860).

结论:

  • 双抗血小板疗法 (DAPT) 没有与经过LT评估的不补偿性肝炎患者的胃肠道出血风险增加有关.
  • 在这种特定患者群体中,DAPT似乎对出血并发症是安全的.
  • 进一步的研究可以为治疗冠状动脉疾病的肝硬化患者提供临床指南.