【medical-news】【资讯翻译】PCI术后消化道出血处理1
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Management of a GI Bleed Post PCI
Patients who suffer a GI bleed after PCIare a challenging group. They may have multiple comorbidities and are oftenmedically unstable; treatment must balance the need to prevent ischemicpost-procedure complications against the risk that GI hemorrhage in theanticoagulated patient represents. Close liaison between cardiologists andgastroenterologists is paramount, as a number of difficult risk–benefitdecisions are required.
There are well-established guidelines forthe management of nonvariceal upper GI bleeding, much of which are valid forpost-PCI bleeding and will not be discussed here, such as resuscitation,disposition and endoscopic techniques. However, certain aspects of managementneed careful consideration in these patients, including use of bloodtransfusions, timing and safety of endoscopy, PPI use, interruption, reversaland reintroduction of anticoagulant and antiplatelet therapy and considerationof surgery.
Blood Transfusion
A consensus statement for use of bloodtransfusion from 1988 still rings true today. It advocates that the decision totransfuse should not based be upon one sole marker, such as a low hemoglobin,but instead rely upon the patient's clinical situation and the need for oxygendelivery. The clinical practice of the authors is to transfuse to hemoglobin of100 g/l following a significant GI bleed in the setting of PCI. We considertransfusion to be of greatest importance when bleeding has been accompanied byhemodynamic compromise, a significant fall in hemoglobin (e.g., >30 g/l) orby the finding of high-risk endoscopic stigmata for rebleeding.
Proton-pump Inhibitors
The issues surrounding the use of PPI as aprophylactic measure have been discussed above. To the best of our knowledge,there are no data regarding the effect of a PPI infusion on clopidogrelefficacy in the setting of a GI bleed post PCI. We recommend that PPI isadministered in accordance with current guidelines.[27] This will involve abolus followed by an infusion prior to endoscopy then continuing either as aninfusion or as a regular oral or intravenous dose depending upon the endoscopicfindings.
Timing & Safety of Endoscopy After PCI
Gastroscopy is safe post PCI providedpatients are hemodynamically stable, which should be the goal of resuscitation.Early and intensive resuscitation of patients who have had a GI bleed improvesmortality.In a retrospective study of 5673 patients who underwent PCI at asingle center, 70 patients suffered an upper GI hemorrhage within 30 days, 65of whom underwent gastroscopy during that same admission. There were nosignificant complications in this cohort. An earlier case–control study of 200patients who underwent gastroscopy a median of 9.1 days after MI had asignificantly higher rate of serious complications than the control group (7.5vs 1.5%).However, those with complications typically had hemodynamicinstability and higher APACHE II scores, highlighting the need for adequateresuscitation pregastroscopy.
另外，如使用翻译软件翻译，被发现者扣分1-2分
翻译时参照版规
http://news.dxy.cn/bbs/topic/8600034 【注意编译和统计字数】
翻译三天未加分找
http://news.dxy.cn/bbs/topic/7560523
举报和合并加分专贴
http://news.dxy.cn/bbs/topic/22202798
Management of a GI Bleed Post PCI
Patients who suffer a GI bleed after PCIare a challenging group. They may have multiple comorbidities and are oftenmedically unstable; treatment must balance the need to prevent ischemicpost-procedure complications against the risk that GI hemorrhage in theanticoagulated patient represents. Close liaison between cardiologists andgastroenterologists is paramount, as a number of difficult risk–benefitdecisions are required.
There are well-established guidelines forthe management of nonvariceal upper GI bleeding, much of which are valid forpost-PCI bleeding and will not be discussed here, such as resuscitation,disposition and endoscopic techniques. However, certain aspects of managementneed careful consideration in these patients, including use of bloodtransfusions, timing and safety of endoscopy, PPI use, interruption, reversaland reintroduction of anticoagulant and antiplatelet therapy and considerationof surgery.
Blood Transfusion
A consensus statement for use of bloodtransfusion from 1988 still rings true today. It advocates that the decision totransfuse should not based be upon one sole marker, such as a low hemoglobin,but instead rely upon the patient's clinical situation and the need for oxygendelivery. The clinical practice of the authors is to transfuse to hemoglobin of100 g/l following a significant GI bleed in the setting of PCI. We considertransfusion to be of greatest importance when bleeding has been accompanied byhemodynamic compromise, a significant fall in hemoglobin (e.g., >30 g/l) orby the finding of high-risk endoscopic stigmata for rebleeding.
Proton-pump Inhibitors
The issues surrounding the use of PPI as aprophylactic measure have been discussed above. To the best of our knowledge,there are no data regarding the effect of a PPI infusion on clopidogrelefficacy in the setting of a GI bleed post PCI. We recommend that PPI isadministered in accordance with current guidelines.[27] This will involve abolus followed by an infusion prior to endoscopy then continuing either as aninfusion or as a regular oral or intravenous dose depending upon the endoscopicfindings.
Timing & Safety of Endoscopy After PCI
Gastroscopy is safe post PCI providedpatients are hemodynamically stable, which should be the goal of resuscitation.Early and intensive resuscitation of patients who have had a GI bleed improvesmortality.In a retrospective study of 5673 patients who underwent PCI at asingle center, 70 patients suffered an upper GI hemorrhage within 30 days, 65of whom underwent gastroscopy during that same admission. There were nosignificant complications in this cohort. An earlier case–control study of 200patients who underwent gastroscopy a median of 9.1 days after MI had asignificantly higher rate of serious complications than the control group (7.5vs 1.5%).However, those with complications typically had hemodynamicinstability and higher APACHE II scores, highlighting the need for adequateresuscitation pregastroscopy.
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