Кровотечения из верхних отделов желудочно-кишечного тракта у пациентов со стабильной ишемической болезнью сердца (по результатам проспективного РЕГистра длительной Антитромботической ТерАпии – РЕГАТА) - Журнал Терапевтический архив №9 Вопросы кардиологии 2020
Кровотечения из верхних отделов желудочно-кишечного тракта у пациентов со стабильной ишемической болезнью сердца (по результатам проспективного РЕГистра длительной Антитромботической ТерАпии – РЕГАТА)
Шахматова О.О., Комаров А.Л., Коробкова В.В. и др. Кровотечения из верхних отделов желудочно-кишечного тракта у пациентов со стабильной ишемической болезнью сердца (по результатам проспективного РЕГистра длительной Антитромботической ТерАпии – РЕГАТА). Терапевтический архив. 2020; 92 (9): 30–38. DOI: 10.26442/00403660.2020.09.000699
DOI: 10.26442/00403660.2020.09.000699
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DOI: 10.26442/00403660.2020.09.000699
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Аннотация
Введение. Желудочно-кишечные кровотечения (ЖКК) являются частыми осложнениями антитромбоцитарной терапии. Данные из реальной клинической практики, характеризующие спектр факторов риска ЖКК, профилактическое назначение ингибиторов протонной помпы (ИПП), частоту кровотечений и их отдаленные последствия у пациентов со стабильной ишемической болезнью сердца (ИБС), ограниченны.
Цель. Выявить предикторы ЖКК у пациентов со стабильной ИБС, оценить роль ИПП в профилактике кровотечений и долгосрочный прогноз пациентов после перенесенных ЖКК.
Материалы и методы. В одноцентровый проспективный РЕГистр длительной Антитромботической ТерАпии (РЕГАТА) включены
934 больных со стабильной ИБС (медиана возраста 61 [53–68] год, 78,6% мужчин). По усмотрению врача проводились скрининг на наличие атеросклероза периферических артерий (АПА) и аневризмы брюшной аорты (АБА), эзофагогастродуоденоскопия. Двойную антитромбоцитарную терапию получали 76% больных в течение 6–12 мес после плановых чрескожных коронарных вмешательств. ИПП назначались в 28,3% случаев.
Результаты. Медиана длительности наблюдения составила 2,5 [1,1–5,1] года. Частота ЖКК – 1,9 на 100 пациентов в год. Анамнез язвенной болезни (отношение шансов – ОШ 4,7; доверительный интервал – 95% ДИ 1,9–11,8; p=0,001), эрозий верхних отделов желудочно-кишечного тракта (ОШ 6,7; 2,7–16,6; p=0,00004), а также сопутствующие заболевания, ассоциирующиеся со снижением кровоснабжения слизистой оболочки, такие как хроническая сердечная недостаточность (ОШ 6,1; 2,3–16,0; p=0,0002), АБА (ОШ 9,3; 2,5–34,2; p=0,0008) и АПА (ОШ 2,3; 0,98–5,5; р=0,05) оказались независимыми предикторами ЖКК. Частота АБА среди перенесших ЖКК составила 19,6% (у пациентов без ЖКК – 1,4%; р<0,001). Получали ИПП 90,2% пациентов, перенесших ЖКК; частота ЖКК у принимающих пантопразол и омепразол достоверно не различалась. После ЖКК частота рецидивов кровотечения составила 7,8%, тромботических осложнений – 31,4%, смертность – 17,7% в течение 30 дней, 19,4% в течение 1 года и 35,3% за весь период наблюдения. Предикторами смертельных исходов оказались АБА (ОШ 92,5; 7,7–107,9; p<0,0001), АПА (ОШ 4,2; 1,03–17,2; p=0,045) и хроническая сердечная недостаточность (ОШ 34,5; 8,5–140,6; p<0,0001). Наихудший прогноз ожидал больных, которые перенесли ЖКК и тромботические осложнения: 2/3 таких пациентов умерли.
Заключение. У пациентов со стабильной ИБС предикторами ЖКК и последующего неблагоприятного прогноза являются факторы, отражающие «бремя» атеротромбоза, – АБА, периферический атеросклероз и хроническая сердечная недостаточность. Регистрация: https://www.clinicaltrials.gov; уникальный номер NCT04347200.
Ключевые слова: желудочно-кишечное кровотечение, стабильная ИБС, аневризма брюшного отдела аорты, атеросклероз периферических артерий, ингибиторы протонной помпы, матриксные металлопротеиназы, смертность, тромботические осложнения.
Aim. To identify predictors of UGI bleeding in patients with stable CAD, to assess the role of PPI in the prevention of bleeding and the long-term prognosis of patients after bleeding.
Materials and methods. 934 patients with stable CAD (median age 61 [53–68] years, 78.6% men) were included in the single institution prospective REGistry of Long-term AnTithrombotic TherApy (REGATTA). Atherosclerosis of peripheral arteries (APA) and abdominal aortic aneurysm (AAA) screening was performed by doctor decision, as well as esophagogastroduodenoscopy. 76% of patients received dual antiplatelet therapy for 6–12 months after elective PCI. PPIs were prescribed in 28.3% of cases.
Results. The median follow-up was 2.5 [1.1–5.1] years. The frequency of overt UGI bleeding was 1.9 per 100 patients per year.
Anamnesis of peptic ulcer disease (OR 4.7; 95% CI 1.9–11.8; p=0.001), erosion of the upper gastrointestinal tract (OR 6.7; 2.7–16.6; p=0.00004 ), as well as concomitant diseases associated with a decrease in blood supply to the mucosa, such as heart failure – HF (OR 6.1; 2.3–16.0; p=0.0002), AAA (OR 9.3; 2.5–34.2; p=0.0008) and APA (OR 2.3; 0.98–5.5; p=0.05) turned out to be independent predictors of UGI bleeding. The frequency of AAA among those who underwent UGI bleeding was 19.6% (in patients without bleeding – 1.4%; p<0.001). 90.2% of patients with UGI bleeding received PPI; the frequency of UGI bleeding in patients receiving pantoprazole and omeprazole did not differ significantly. After UGI bleeding, rebleeding rate was 7.8%, thrombotic events (TE) rate – 31.4%, mortality rate – 17.7% for 30 days, 19.4% for 1 year and 35.3% for the entire observation period. The predictors of deaths were AAA (OR 92.5; 7.7–107.9; p<0.0001), APA (OR 4.2; 1.03–17.2; p=0.045) and HF (OR 34.5; 8.5–140.6; p<0.0001). The worst prognosis was expected for patients who underwent UGI bleeding and thrombotic events: 2/3 of these patients died.
Conclusion. In a prospective analysis of patients with stable CAD, we identified UGI bleeding was a significant risk factor for late thromboembolism and death, compared with patients without bleeding. Predictors of UGI bleeding and poor prognosis are factors that indicate atherothrombotic burden – abdominal aortic aneurysm, peripheral atherosclerosis and HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04347200.
Keywords: upper gastrointestinal bleeding, UGI bleeding, stable CAD, abdominal aortic aneurysm, peripheral arterial atherosclerosis, proton pump inhibitors, matrix metalloproteinases, mortality, thrombotic complications.
Цель. Выявить предикторы ЖКК у пациентов со стабильной ИБС, оценить роль ИПП в профилактике кровотечений и долгосрочный прогноз пациентов после перенесенных ЖКК.
Материалы и методы. В одноцентровый проспективный РЕГистр длительной Антитромботической ТерАпии (РЕГАТА) включены
934 больных со стабильной ИБС (медиана возраста 61 [53–68] год, 78,6% мужчин). По усмотрению врача проводились скрининг на наличие атеросклероза периферических артерий (АПА) и аневризмы брюшной аорты (АБА), эзофагогастродуоденоскопия. Двойную антитромбоцитарную терапию получали 76% больных в течение 6–12 мес после плановых чрескожных коронарных вмешательств. ИПП назначались в 28,3% случаев.
Результаты. Медиана длительности наблюдения составила 2,5 [1,1–5,1] года. Частота ЖКК – 1,9 на 100 пациентов в год. Анамнез язвенной болезни (отношение шансов – ОШ 4,7; доверительный интервал – 95% ДИ 1,9–11,8; p=0,001), эрозий верхних отделов желудочно-кишечного тракта (ОШ 6,7; 2,7–16,6; p=0,00004), а также сопутствующие заболевания, ассоциирующиеся со снижением кровоснабжения слизистой оболочки, такие как хроническая сердечная недостаточность (ОШ 6,1; 2,3–16,0; p=0,0002), АБА (ОШ 9,3; 2,5–34,2; p=0,0008) и АПА (ОШ 2,3; 0,98–5,5; р=0,05) оказались независимыми предикторами ЖКК. Частота АБА среди перенесших ЖКК составила 19,6% (у пациентов без ЖКК – 1,4%; р<0,001). Получали ИПП 90,2% пациентов, перенесших ЖКК; частота ЖКК у принимающих пантопразол и омепразол достоверно не различалась. После ЖКК частота рецидивов кровотечения составила 7,8%, тромботических осложнений – 31,4%, смертность – 17,7% в течение 30 дней, 19,4% в течение 1 года и 35,3% за весь период наблюдения. Предикторами смертельных исходов оказались АБА (ОШ 92,5; 7,7–107,9; p<0,0001), АПА (ОШ 4,2; 1,03–17,2; p=0,045) и хроническая сердечная недостаточность (ОШ 34,5; 8,5–140,6; p<0,0001). Наихудший прогноз ожидал больных, которые перенесли ЖКК и тромботические осложнения: 2/3 таких пациентов умерли.
Заключение. У пациентов со стабильной ИБС предикторами ЖКК и последующего неблагоприятного прогноза являются факторы, отражающие «бремя» атеротромбоза, – АБА, периферический атеросклероз и хроническая сердечная недостаточность. Регистрация: https://www.clinicaltrials.gov; уникальный номер NCT04347200.
Ключевые слова: желудочно-кишечное кровотечение, стабильная ИБС, аневризма брюшного отдела аорты, атеросклероз периферических артерий, ингибиторы протонной помпы, матриксные металлопротеиназы, смертность, тромботические осложнения.
________________________________________________
Aim. To identify predictors of UGI bleeding in patients with stable CAD, to assess the role of PPI in the prevention of bleeding and the long-term prognosis of patients after bleeding.
Materials and methods. 934 patients with stable CAD (median age 61 [53–68] years, 78.6% men) were included in the single institution prospective REGistry of Long-term AnTithrombotic TherApy (REGATTA). Atherosclerosis of peripheral arteries (APA) and abdominal aortic aneurysm (AAA) screening was performed by doctor decision, as well as esophagogastroduodenoscopy. 76% of patients received dual antiplatelet therapy for 6–12 months after elective PCI. PPIs were prescribed in 28.3% of cases.
Results. The median follow-up was 2.5 [1.1–5.1] years. The frequency of overt UGI bleeding was 1.9 per 100 patients per year.
Anamnesis of peptic ulcer disease (OR 4.7; 95% CI 1.9–11.8; p=0.001), erosion of the upper gastrointestinal tract (OR 6.7; 2.7–16.6; p=0.00004 ), as well as concomitant diseases associated with a decrease in blood supply to the mucosa, such as heart failure – HF (OR 6.1; 2.3–16.0; p=0.0002), AAA (OR 9.3; 2.5–34.2; p=0.0008) and APA (OR 2.3; 0.98–5.5; p=0.05) turned out to be independent predictors of UGI bleeding. The frequency of AAA among those who underwent UGI bleeding was 19.6% (in patients without bleeding – 1.4%; p<0.001). 90.2% of patients with UGI bleeding received PPI; the frequency of UGI bleeding in patients receiving pantoprazole and omeprazole did not differ significantly. After UGI bleeding, rebleeding rate was 7.8%, thrombotic events (TE) rate – 31.4%, mortality rate – 17.7% for 30 days, 19.4% for 1 year and 35.3% for the entire observation period. The predictors of deaths were AAA (OR 92.5; 7.7–107.9; p<0.0001), APA (OR 4.2; 1.03–17.2; p=0.045) and HF (OR 34.5; 8.5–140.6; p<0.0001). The worst prognosis was expected for patients who underwent UGI bleeding and thrombotic events: 2/3 of these patients died.
Conclusion. In a prospective analysis of patients with stable CAD, we identified UGI bleeding was a significant risk factor for late thromboembolism and death, compared with patients without bleeding. Predictors of UGI bleeding and poor prognosis are factors that indicate atherothrombotic burden – abdominal aortic aneurysm, peripheral atherosclerosis and HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04347200.
Keywords: upper gastrointestinal bleeding, UGI bleeding, stable CAD, abdominal aortic aneurysm, peripheral arterial atherosclerosis, proton pump inhibitors, matrix metalloproteinases, mortality, thrombotic complications.
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2. Ducrocq G, Schulte PJ, Becker RC, et al. Association of spontaneous and procedure-related bleeds with short- and longterm mortality after acute coronary syndromes: an analysis from the PLATO trial. EuroIntervention. 2015;11:737-45. doi: 10.4244/eijy14m09_11
3. Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. J Am Coll Cardiol. 2010;56(24):2051-66. doi: 10.1016/j.jacc.2010.09.010
4. Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. N Engl J Med. 2002;346:2033-8. doi: 10.1056/nejmoa012877
5. Taha AS, McCloskey C, Prasad R, Bezlyak V. Famotidine for the prevention of peptic ulcers and oesophagitis in patients taking low-dose aspirin (FAMOUS): a phase III, randomised, double-blind, placebo-controlled trial. Lancet. 2009;374:119-25. doi: 10.1016/S0140-6736(09)61246-0
6. Bhatt DL, Cryer BL, Contant CF, et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med. 2010;363:1909-17. doi: 10.1056/nejmoa1007964
7. Moayyedi P, Eikelboom JW, Bosch J, et al. Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial. Gastroenterology. 2019;157(2):403-412.e5. doi: 10.1053/j.gastro.2019.04.041
8. Lanas A, Garcia-Rodriguez LA, Arroyo MT, et al. Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. Am J Gastroenterol. 2007;102:507-15. doi: 10.1111/j.1572-0241.2006.01062.x
9. Ng FH, Wong SY, Lam KF, et al. Famotidine is inferior to pantoprazole in preventing recurrence of aspirin-related peptic ulcers or erosions. Gastroenterology. 2010;138:82-8. doi: 10.1053/j.gastro.2009.09.063
10. Scheiman JM. The use of proton pump inhibitors in treating and preventing NSAID-induced mucosal damage. Arthritis Res Ther. 2013;15:S5. doi: 10.1186/ar4177
11. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2016;37:267-315. doi: 10.1093/eurheartj/ehv320
12. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119-77. doi: 10.1093/eurheartj/ehx393
13. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J. 2018;39:213-60. doi: 10.1093/eurheartj/ehx419
14. Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. doi: 10.1093/eurheartj/ehy394
15. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(3):407-77. doi: 10.1093/eurheartj/ehz425
16. Patrono C, Bachmann F, Baigent C, et al. Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European society of cardiology. Eur Heart J. 2004;25(2):166-81. doi: 10.1016/j.ehj.2003.10.013
17. Romera Barba E, Sánchez Pérez A, Bertelli Puche J, et al. Primary aorto-duodenal fistula: A rare but potentially fatal cause of gastrointestinal bleeding. Cir Esp. 2015;93(2):121-3. doi: 10.1016/j.cireng.2014.12.008
18. Jensen BES, Hansen JM, Larsen KS, et al. Randomized clinical trial: the impact of gastrointestinal risk factor screening and prophylactic proton pump inhibitor therapy in patients receiving dual antiplatelet therapy. Eur J Gastroenterol Hepatol. 2017;29:1118-25. doi: 10.1097/MEG.0000000000000934
19. Jones AW, Kirk RS, Bloor K. The association between aneurysm of the abdominal aorta and peptic ulceration. Gut. 1970;11:679-84. doi: 10.1136/gut.11.8.679
20. Cheng SW, Fok M, Wong J. Peptic ulcers and abdominal aortic aneurysms. J Gastroenterol Hepatol. 1992;7(3):302-4. doi: 10.1111/j.1440-1746.1992.tb00985.x
21. Konno H, Kaneko H, Maruo Y, et al. Prevention of gastric ulcer or acute gastric mucosal lesions accompanying bleeding after abdominal aortic aneurysm surgery. World J Surg. 1994;18(6):944-7. doi: 10.1007/bf00299117
22. Pabst TS, Bernhard VM, McIntyre KE, et al. Gastrointestinal bleeding after aortic surgery. J Vasc Surg. 1988;8:280-5. doi: 10.1016/0741-5214(88)90279-0
23. Konno H, Sakaguchi S, Hachiya T. Bleeding peptic ulcer after abdominal aortic aneurysm surgery. Arch Surg. 1991;126(7):894-7. doi: 10.1001/archsurg.1991.01410310104016
24. Elkeles A. Gastric ulcer in the aged and calcified atherosclerosis. AJR Am J Roentgenol. 1964;91:744-50.
25. Rabkin SW. The Role Matrix Metalloproteinases in the Production of Aortic Aneurysm. Prog Mol Biol Transl Sci. 2017;147:239-65. doi: 10.1016/bs.pmbts.2017.02.002
26. Li SL, Zhao JR, Ren XY, et al. Increased expression of matrix metalloproteinase-9 associated with gastric ulcer recurrence. World J Gastroenterol. 2013;19(28):4590-5. doi: 10.3748/wjg.v19.i28.4590
27. Yeh Y, Cheng H, Chang W, et al. Matrix metalloproteinase-3 promoter polymorphisms but not dupA-H. pylori correlate to duodenal ulcers in H. pylori-infected females. BMC Microbiol. 2010;10:218. doi: 10.1186/1471-2180-10-218
28. Kwon OS, Jung HS, Bae KS, et al. Increased serum activity of matrix metalloproteinase-9 in patients with acute variceal bleeding. Gut Liver. 2012;6(2):249-55. doi: 10.5009/gnl.2012.6.2.249
29. Moayyedi P, Eikelboom JW, Bosch J, et al. Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin. Gastroenterology. 2019;157(3):682-691.e2. doi: 10.1053/j.gastro.2019.05.056
30. Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017;152:706-15. doi: 10.1053/j.gastro.2017.01.031
31. Mohan V, Talmi-Frank D, Arkadash V, et al. Matrix metalloproteinase protein inhibitors: highlighting a new beginning for metalloproteinases in medicine. Metalloproteinases In Medicine. 2016;3:31-47. doi: 10.2147/mnm.s65143
32. Singh LP, Mishra A, Saha D, Swarnakar S. Doxycycline blocks gastric ulcer by regulating matrix metalloproteinase-2 activity and oxidative stress. World J Gastroenterol. 2011;17(28):3310-21. doi: 10.3748/wjg.v17.i28.3310
33. Nagata N, Sakurai T, Shimbo T, et al. Acute severe gastrointestinal tract bleeding is associated with an increased risk of thromboembolism and death. Clin Gastroenterol Hepatol. 2017;15:1882-9. doi: 10.1016/j.cgh.2017.06.028
34. Laursen SB, Hansen JM, Hallas J, et al. The excess long-term mortality in peptic ulcer bleeding is explained by nonspecific comorbidity. Scand J Gastroenterol. 2015;50:145-52. doi: 10.3109/00365521.2014.992365
2. Ducrocq G, Schulte PJ, Becker RC, et al. Association of spontaneous and procedure-related bleeds with short- and longterm mortality after acute coronary syndromes: an analysis from the PLATO trial. EuroIntervention. 2015;11:737-45. doi: 10.4244/eijy14m09_11
3. Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. J Am Coll Cardiol. 2010;56(24):2051-66. doi: 10.1016/j.jacc.2010.09.010
4. Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. N Engl J Med. 2002;346:2033-8. doi: 10.1056/nejmoa012877
5. Taha AS, McCloskey C, Prasad R, Bezlyak V. Famotidine for the prevention of peptic ulcers and oesophagitis in patients taking low-dose aspirin (FAMOUS): a phase III, randomised, double-blind, placebo-controlled trial. Lancet. 2009;374:119-25. doi: 10.1016/S0140-6736(09)61246-0
6. Bhatt DL, Cryer BL, Contant CF, et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med. 2010;363:1909-17. doi: 10.1056/nejmoa1007964
7. Moayyedi P, Eikelboom JW, Bosch J, et al. Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial. Gastroenterology. 2019;157(2):403-412.e5. doi: 10.1053/j.gastro.2019.04.041
8. Lanas A, Garcia-Rodriguez LA, Arroyo MT, et al. Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. Am J Gastroenterol. 2007;102:507-15. doi: 10.1111/j.1572-0241.2006.01062.x
9. Ng FH, Wong SY, Lam KF, et al. Famotidine is inferior to pantoprazole in preventing recurrence of aspirin-related peptic ulcers or erosions. Gastroenterology. 2010;138:82-8. doi: 10.1053/j.gastro.2009.09.063
10. Scheiman JM. The use of proton pump inhibitors in treating and preventing NSAID-induced mucosal damage. Arthritis Res Ther. 2013;15:S5. doi: 10.1186/ar4177
11. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2016;37:267-315. doi: 10.1093/eurheartj/ehv320
12. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119-77. doi: 10.1093/eurheartj/ehx393
13. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J. 2018;39:213-60. doi: 10.1093/eurheartj/ehx419
14. Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. doi: 10.1093/eurheartj/ehy394
15. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(3):407-77. doi: 10.1093/eurheartj/ehz425
16. Patrono C, Bachmann F, Baigent C, et al. Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European society of cardiology. Eur Heart J. 2004;25(2):166-81. doi: 10.1016/j.ehj.2003.10.013
17. Romera Barba E, Sánchez Pérez A, Bertelli Puche J, et al. Primary aorto-duodenal fistula: A rare but potentially fatal cause of gastrointestinal bleeding. Cir Esp. 2015;93(2):121-3. doi: 10.1016/j.cireng.2014.12.008
18. Jensen BES, Hansen JM, Larsen KS, et al. Randomized clinical trial: the impact of gastrointestinal risk factor screening and prophylactic proton pump inhibitor therapy in patients receiving dual antiplatelet therapy. Eur J Gastroenterol Hepatol. 2017;29:1118-25. doi: 10.1097/MEG.0000000000000934
19. Jones AW, Kirk RS, Bloor K. The association between aneurysm of the abdominal aorta and peptic ulceration. Gut. 1970;11:679-84. doi: 10.1136/gut.11.8.679
20. Cheng SW, Fok M, Wong J. Peptic ulcers and abdominal aortic aneurysms. J Gastroenterol Hepatol. 1992;7(3):302-4. doi: 10.1111/j.1440-1746.1992.tb00985.x
21. Konno H, Kaneko H, Maruo Y, et al. Prevention of gastric ulcer or acute gastric mucosal lesions accompanying bleeding after abdominal aortic aneurysm surgery. World J Surg. 1994;18(6):944-7. doi: 10.1007/bf00299117
22. Pabst TS, Bernhard VM, McIntyre KE, et al. Gastrointestinal bleeding after aortic surgery. J Vasc Surg. 1988;8:280-5. doi: 10.1016/0741-5214(88)90279-0
23. Konno H, Sakaguchi S, Hachiya T. Bleeding peptic ulcer after abdominal aortic aneurysm surgery. Arch Surg. 1991;126(7):894-7. doi: 10.1001/archsurg.1991.01410310104016
24. Elkeles A. Gastric ulcer in the aged and calcified atherosclerosis. AJR Am J Roentgenol. 1964;91:744-50.
25. Rabkin SW. The Role Matrix Metalloproteinases in the Production of Aortic Aneurysm. Prog Mol Biol Transl Sci. 2017;147:239-65. doi: 10.1016/bs.pmbts.2017.02.002
26. Li SL, Zhao JR, Ren XY, et al. Increased expression of matrix metalloproteinase-9 associated with gastric ulcer recurrence. World J Gastroenterol. 2013;19(28):4590-5. doi: 10.3748/wjg.v19.i28.4590
27. Yeh Y, Cheng H, Chang W, et al. Matrix metalloproteinase-3 promoter polymorphisms but not dupA-H. pylori correlate to duodenal ulcers in H. pylori-infected females. BMC Microbiol. 2010;10:218. doi: 10.1186/1471-2180-10-218
28. Kwon OS, Jung HS, Bae KS, et al. Increased serum activity of matrix metalloproteinase-9 in patients with acute variceal bleeding. Gut Liver. 2012;6(2):249-55. doi: 10.5009/gnl.2012.6.2.249
29. Moayyedi P, Eikelboom JW, Bosch J, et al. Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin. Gastroenterology. 2019;157(3):682-691.e2. doi: 10.1053/j.gastro.2019.05.056
30. Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017;152:706-15. doi: 10.1053/j.gastro.2017.01.031
31. Mohan V, Talmi-Frank D, Arkadash V, et al. Matrix metalloproteinase protein inhibitors: highlighting a new beginning for metalloproteinases in medicine. Metalloproteinases In Medicine. 2016;3:31-47. doi: 10.2147/mnm.s65143
32. Singh LP, Mishra A, Saha D, Swarnakar S. Doxycycline blocks gastric ulcer by regulating matrix metalloproteinase-2 activity and oxidative stress. World J Gastroenterol. 2011;17(28):3310-21. doi: 10.3748/wjg.v17.i28.3310
33. Nagata N, Sakurai T, Shimbo T, et al. Acute severe gastrointestinal tract bleeding is associated with an increased risk of thromboembolism and death. Clin Gastroenterol Hepatol. 2017;15:1882-9. doi: 10.1016/j.cgh.2017.06.028
34. Laursen SB, Hansen JM, Hallas J, et al. The excess long-term mortality in peptic ulcer bleeding is explained by nonspecific comorbidity. Scand J Gastroenterol. 2015;50:145-52. doi: 10.3109/00365521.2014.992365
________________________________________________
2. Ducrocq G, Schulte PJ, Becker RC, et al. Association of spontaneous and procedure-related bleeds with short- and longterm mortality after acute coronary syndromes: an analysis from the PLATO trial. EuroIntervention. 2015;11:737-45. doi: 10.4244/eijy14m09_11
3. Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. J Am Coll Cardiol. 2010;56(24):2051-66. doi: 10.1016/j.jacc.2010.09.010
4. Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. N Engl J Med. 2002;346:2033-8. doi: 10.1056/nejmoa012877
5. Taha AS, McCloskey C, Prasad R, Bezlyak V. Famotidine for the prevention of peptic ulcers and oesophagitis in patients taking low-dose aspirin (FAMOUS): a phase III, randomised, double-blind, placebo-controlled trial. Lancet. 2009;374:119-25. doi: 10.1016/S0140-6736(09)61246-0
6. Bhatt DL, Cryer BL, Contant CF, et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med. 2010;363:1909-17. doi: 10.1056/nejmoa1007964
7. Moayyedi P, Eikelboom JW, Bosch J, et al. Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial. Gastroenterology. 2019;157(2):403-412.e5. doi: 10.1053/j.gastro.2019.04.041
8. Lanas A, Garcia-Rodriguez LA, Arroyo MT, et al. Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. Am J Gastroenterol. 2007;102:507-15. doi: 10.1111/j.1572-0241.2006.01062.x
9. Ng FH, Wong SY, Lam KF, et al. Famotidine is inferior to pantoprazole in preventing recurrence of aspirin-related peptic ulcers or erosions. Gastroenterology. 2010;138:82-8. doi: 10.1053/j.gastro.2009.09.063
10. Scheiman JM. The use of proton pump inhibitors in treating and preventing NSAID-induced mucosal damage. Arthritis Res Ther. 2013;15:S5. doi: 10.1186/ar4177
11. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2016;37:267-315. doi: 10.1093/eurheartj/ehv320
12. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119-77. doi: 10.1093/eurheartj/ehx393
13. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J. 2018;39:213-60. doi: 10.1093/eurheartj/ehx419
14. Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165. doi: 10.1093/eurheartj/ehy394
15. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(3):407-77. doi: 10.1093/eurheartj/ehz425
16. Patrono C, Bachmann F, Baigent C, et al. Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European society of cardiology. Eur Heart J. 2004;25(2):166-81. doi: 10.1016/j.ehj.2003.10.013
17. Romera Barba E, Sánchez Pérez A, Bertelli Puche J, et al. Primary aorto-duodenal fistula: A rare but potentially fatal cause of gastrointestinal bleeding. Cir Esp. 2015;93(2):121-3. doi: 10.1016/j.cireng.2014.12.008
18. Jensen BES, Hansen JM, Larsen KS, et al. Randomized clinical trial: the impact of gastrointestinal risk factor screening and prophylactic proton pump inhibitor therapy in patients receiving dual antiplatelet therapy. Eur J Gastroenterol Hepatol. 2017;29:1118-25. doi: 10.1097/MEG.0000000000000934
19. Jones AW, Kirk RS, Bloor K. The association between aneurysm of the abdominal aorta and peptic ulceration. Gut. 1970;11:679-84. doi: 10.1136/gut.11.8.679
20. Cheng SW, Fok M, Wong J. Peptic ulcers and abdominal aortic aneurysms. J Gastroenterol Hepatol. 1992;7(3):302-4. doi: 10.1111/j.1440-1746.1992.tb00985.x
21. Konno H, Kaneko H, Maruo Y, et al. Prevention of gastric ulcer or acute gastric mucosal lesions accompanying bleeding after abdominal aortic aneurysm surgery. World J Surg. 1994;18(6):944-7. doi: 10.1007/bf00299117
22. Pabst TS, Bernhard VM, McIntyre KE, et al. Gastrointestinal bleeding after aortic surgery. J Vasc Surg. 1988;8:280-5. doi: 10.1016/0741-5214(88)90279-0
23. Konno H, Sakaguchi S, Hachiya T. Bleeding peptic ulcer after abdominal aortic aneurysm surgery. Arch Surg. 1991;126(7):894-7. doi: 10.1001/archsurg.1991.01410310104016
24. Elkeles A. Gastric ulcer in the aged and calcified atherosclerosis. AJR Am J Roentgenol. 1964;91:744-50.
25. Rabkin SW. The Role Matrix Metalloproteinases in the Production of Aortic Aneurysm. Prog Mol Biol Transl Sci. 2017;147:239-65. doi: 10.1016/bs.pmbts.2017.02.002
26. Li SL, Zhao JR, Ren XY, et al. Increased expression of matrix metalloproteinase-9 associated with gastric ulcer recurrence. World J Gastroenterol. 2013;19(28):4590-5. doi: 10.3748/wjg.v19.i28.4590
27. Yeh Y, Cheng H, Chang W, et al. Matrix metalloproteinase-3 promoter polymorphisms but not dupA-H. pylori correlate to duodenal ulcers in H. pylori-infected females. BMC Microbiol. 2010;10:218. doi: 10.1186/1471-2180-10-218
28. Kwon OS, Jung HS, Bae KS, et al. Increased serum activity of matrix metalloproteinase-9 in patients with acute variceal bleeding. Gut Liver. 2012;6(2):249-55. doi: 10.5009/gnl.2012.6.2.249
29. Moayyedi P, Eikelboom JW, Bosch J, et al. Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin. Gastroenterology. 2019;157(3):682-691.e2. doi: 10.1053/j.gastro.2019.05.056
30. Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology. 2017;152:706-15. doi: 10.1053/j.gastro.2017.01.031
31. Mohan V, Talmi-Frank D, Arkadash V, et al. Matrix metalloproteinase protein inhibitors: highlighting a new beginning for metalloproteinases in medicine. Metalloproteinases In Medicine. 2016;3:31-47. doi: 10.2147/mnm.s65143
32. Singh LP, Mishra A, Saha D, Swarnakar S. Doxycycline blocks gastric ulcer by regulating matrix metalloproteinase-2 activity and oxidative stress. World J Gastroenterol. 2011;17(28):3310-21. doi: 10.3748/wjg.v17.i28.3310
33. Nagata N, Sakurai T, Shimbo T, et al. Acute severe gastrointestinal tract bleeding is associated with an increased risk of thromboembolism and death. Clin Gastroenterol Hepatol. 2017;15:1882-9. doi: 10.1016/j.cgh.2017.06.028
34. Laursen SB, Hansen JM, Hallas J, et al. The excess long-term mortality in peptic ulcer bleeding is explained by nonspecific comorbidity. Scand J Gastroenterol. 2015;50:145-52. doi: 10.3109/00365521.2014.992365
Авторы
О.О. Шахматова1, А.Л. Комаров1, В.В. Коробкова1, Е.Б. Яровая1,2, М.В. Андреевская1, А.Г. Шулешова1, Е.П. Панченко1
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова», Москва, Россия
1 National Medical Research Center of Cardiology, Moscow, Russia;
2 Lomonosov Moscow State University, Moscow, Russia
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова», Москва, Россия
________________________________________________
1 National Medical Research Center of Cardiology, Moscow, Russia;
2 Lomonosov Moscow State University, Moscow, Russia
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