AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis.METHODS: From 2001 to October 200...AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis.METHODS: From 2001 to October 2003, we studied GIB in 13 502 workers constructing the railroad on Mountain Tanggula which is 4905 m above the sea level. The incidence of GIB in workers at different altitudes was recorded. Endoscopy was performed when the workers evacuated to Golmud (2808 m) and Xining (2261 m). The available data on altitude GIB were analyzed.RESULTS: The overall incidence of GIB was 0.49% in 13 502 workers. The incidence increased with increasing altitude. The onset of symptoms in most patients was within three weeks after arrival at high altitude. Bleeding manifested as hematemesis, melaena or hematochezia, and might be occult. Endoscopic examination showed that the causes of altitude GIB included hemorrhage gastritis, gastric ulcer, duodenal ulcer, and gastric erosion. Experimental studies suggested that acute gastric mucosal lesion (AGML) could be induced by hypoxic and cold stress, which might be the pathogenesis of altitude GIB. Those who consumed large amount of alcohol, aspirin or dexamethasone were at a higher risk of developing GIB. Persons who previously suffered from peptic ulcer or high-altitude polycythemia were also at risk of developing GIB. Early diagnosis, evacuation, and treatment led to early recovery. CONCLUSION: GIB is a potentially life threatening disease, if it is not treated promptly and effectively. Early diagnosis, treatment and evacuation lead to an early recovery. Death due to altitude GIB can be avoided if early symptoms and signs are recognized.展开更多
AIM To verify the validity of the endoscopy guidelines for patients taking warfarin or direct oral anticoagulants(DOAC).METHODS We collected data from 218 patients receiving oral anticoagulants(73 DOAC users, 145 warf...AIM To verify the validity of the endoscopy guidelines for patients taking warfarin or direct oral anticoagulants(DOAC).METHODS We collected data from 218 patients receiving oral anticoagulants(73 DOAC users, 145 warfarin users) and 218 patients not receiving any antithrombotics(age-and sexmatched controls) who underwent polypectomy.(1) We evaluated post-polypectomy bleeding(PPB) risk in patients receiving warfarin or DOAC compared with controls;(2) we assessed the risks of PPB and thromboembolism between three AC management methods: Discontinuing AC with heparin bridge(HPB)(endoscopy guideline recommendation), continuing AC, and discontinuing AC without HPB.RESULTS PPB rate was significantly higher in warfarin users and DOAC users compared with controls(13.7% and 13.7% vs 0.9%, P < 0.001), but was not significantly different between rivaroxaban(13.2%), dabigatran(11.1%), and apixaban(13.3%) users. Two thromboembolic events occurred in warfarin users, but none in DOAC users. Compared with the continuing anticoagulant group, the discontinuing anticoagulant with HPB group(guideline recommendation) had a higher PPB rate(10.8% vs 19.6%, P = 0.087). These findings were significantly evident in warfarin but not DOAC users. One thrombotic event occurred in the discontinuing anticoagulant with HPB group and the discontinuing anticoagulant without HPB group; none occurred in the continuing anticoagulant group.CONCLUSION PPB risk was similar between patients taking warfarin and DOAC. Thromboembolism was observed in warfarin users only. The guideline recommendations for HPB should be re-considered.展开更多
Percutaneous coronary intervention(PCI)is an important treatment strategy for patients with coronary artery disease.However,bleeding after PCI significantly increases the mortality risk.The search for prognostic predi...Percutaneous coronary intervention(PCI)is an important treatment strategy for patients with coronary artery disease.However,bleeding after PCI significantly increases the mortality risk.The search for prognostic predictors and optimal antiplatelet therapy for patients with high bleeding risk(HBR)after PCI has been a much researched upon topic in current cardiovascular research.However,there is no widely accepted prognostic model or recommended antiplatelet therapy for patients with PCI-HBR.In this trial,based on prospective multi-center database building,we will analyze the adverse prognostic predictors for patients with PCI-HBR,observe the types of antiplatelet drugs and duration of dual antiplatelet therapy in PCI-HBR patients,and compare the safety and feasibility of different antiplatelet regimens and treatment courses.The prognostic analysis and an appropriate antiplatelet strategy for patients with PCI and high bleeding risk(PPP-PCI)trial will help analyze bleeding risk factors in PCI-HBR patients and explore the appropriate antiplatelet treatment options.This study is registered with ClinicalTrials.gov(NCT05369442).The Research Ethics Committee of West China Hospital authorized this study(2022 Review#269).The trial results will be published in peer-reviewed journals and at conferences.展开更多
基金Supported by the grant LS-CNNSF-30393130, and 973 Program 2006 CB 504100, CB708514, China
文摘AIM: To investigate the gastrointestinal bleeding (GIB) in people from lowland to high altitude and in workers on Mountain Tanggula and its causes as well as treatment and prophylaxis.METHODS: From 2001 to October 2003, we studied GIB in 13 502 workers constructing the railroad on Mountain Tanggula which is 4905 m above the sea level. The incidence of GIB in workers at different altitudes was recorded. Endoscopy was performed when the workers evacuated to Golmud (2808 m) and Xining (2261 m). The available data on altitude GIB were analyzed.RESULTS: The overall incidence of GIB was 0.49% in 13 502 workers. The incidence increased with increasing altitude. The onset of symptoms in most patients was within three weeks after arrival at high altitude. Bleeding manifested as hematemesis, melaena or hematochezia, and might be occult. Endoscopic examination showed that the causes of altitude GIB included hemorrhage gastritis, gastric ulcer, duodenal ulcer, and gastric erosion. Experimental studies suggested that acute gastric mucosal lesion (AGML) could be induced by hypoxic and cold stress, which might be the pathogenesis of altitude GIB. Those who consumed large amount of alcohol, aspirin or dexamethasone were at a higher risk of developing GIB. Persons who previously suffered from peptic ulcer or high-altitude polycythemia were also at risk of developing GIB. Early diagnosis, evacuation, and treatment led to early recovery. CONCLUSION: GIB is a potentially life threatening disease, if it is not treated promptly and effectively. Early diagnosis, treatment and evacuation lead to an early recovery. Death due to altitude GIB can be avoided if early symptoms and signs are recognized.
基金Supported by Grant--in--Aid for Research from the National Center for Global Health and Medicine(29-2001) partly
文摘AIM To verify the validity of the endoscopy guidelines for patients taking warfarin or direct oral anticoagulants(DOAC).METHODS We collected data from 218 patients receiving oral anticoagulants(73 DOAC users, 145 warfarin users) and 218 patients not receiving any antithrombotics(age-and sexmatched controls) who underwent polypectomy.(1) We evaluated post-polypectomy bleeding(PPB) risk in patients receiving warfarin or DOAC compared with controls;(2) we assessed the risks of PPB and thromboembolism between three AC management methods: Discontinuing AC with heparin bridge(HPB)(endoscopy guideline recommendation), continuing AC, and discontinuing AC without HPB.RESULTS PPB rate was significantly higher in warfarin users and DOAC users compared with controls(13.7% and 13.7% vs 0.9%, P < 0.001), but was not significantly different between rivaroxaban(13.2%), dabigatran(11.1%), and apixaban(13.3%) users. Two thromboembolic events occurred in warfarin users, but none in DOAC users. Compared with the continuing anticoagulant group, the discontinuing anticoagulant with HPB group(guideline recommendation) had a higher PPB rate(10.8% vs 19.6%, P = 0.087). These findings were significantly evident in warfarin but not DOAC users. One thrombotic event occurred in the discontinuing anticoagulant with HPB group and the discontinuing anticoagulant without HPB group; none occurred in the continuing anticoagulant group.CONCLUSION PPB risk was similar between patients taking warfarin and DOAC. Thromboembolism was observed in warfarin users only. The guideline recommendations for HPB should be re-considered.
基金supported by the 1-3-5 project for disciplines of excellence—Clinical Research Incubation Project,West China Hospital,Sichuan University(2019HXFH059 and 2021HXFH021)the Natural Science Foundation of China(82100282).
文摘Percutaneous coronary intervention(PCI)is an important treatment strategy for patients with coronary artery disease.However,bleeding after PCI significantly increases the mortality risk.The search for prognostic predictors and optimal antiplatelet therapy for patients with high bleeding risk(HBR)after PCI has been a much researched upon topic in current cardiovascular research.However,there is no widely accepted prognostic model or recommended antiplatelet therapy for patients with PCI-HBR.In this trial,based on prospective multi-center database building,we will analyze the adverse prognostic predictors for patients with PCI-HBR,observe the types of antiplatelet drugs and duration of dual antiplatelet therapy in PCI-HBR patients,and compare the safety and feasibility of different antiplatelet regimens and treatment courses.The prognostic analysis and an appropriate antiplatelet strategy for patients with PCI and high bleeding risk(PPP-PCI)trial will help analyze bleeding risk factors in PCI-HBR patients and explore the appropriate antiplatelet treatment options.This study is registered with ClinicalTrials.gov(NCT05369442).The Research Ethics Committee of West China Hospital authorized this study(2022 Review#269).The trial results will be published in peer-reviewed journals and at conferences.
