Skip to main content
Erschienen in: coloproctology 2/2020

03.04.2020 | Direkte orale Antikoagulanzien | CME Zertifizierte Fortbildung

Medikamenteninduzierte gastrointestinale Blutung

verfasst von: Prof. Dr. med. W. Fischbach

Erschienen in: coloproctology | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten

Zusammenfassung

Gastrointestinale Blutungen sind vor allem bei älteren Menschen ein häufiges und im Einzelfall bedrohliches Ereignis. Oft liegt eine medikamenteninduzierte Ursache vor. Medikamente, die zu einer gastrointestinalen Blutung führen können, sind vor allem nichtsteroidale Antirheumatika wie Diclofenac oder Ibuprofen, Thrombozytenaggregationshemmer wie Acetylsalicylsäure, Clopidogrel oder Prasugrel und Antikoagulanzien wie die Vitamin-K-Antagonisten, Heparin oder die direkten oralen Antikoagulanzien. Eine Kombinationsbehandlung, beispielsweise eine duale Plättchenhemmung oder Thrombozytenaggregationshemmung plus Antikoagulation, geht mit einem höheren Blutungsrisiko einher als eine Monotherapie. Es gibt Möglichkeiten der Primär- und Sekundärprävention wie die Helicobacter-pylori-Eradikation oder die Begleitmedikation mit einem Protonenpumpeninhibitor.
Literatur
1.
Zurück zum Zitat Rollhauser C, Fleischer DE (2004) Nonvariceal upper gastrointestinal bleeding. Endoscopy 36:52–58CrossRef Rollhauser C, Fleischer DE (2004) Nonvariceal upper gastrointestinal bleeding. Endoscopy 36:52–58CrossRef
2.
Zurück zum Zitat Ohmann C, Imhof M, Ruppert C et al (2005) Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 40:914–920CrossRef Ohmann C, Imhof M, Ruppert C et al (2005) Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 40:914–920CrossRef
3.
Zurück zum Zitat Crooks CJ, West J, Card TR (2013) Comorbidities affect risk of nonvariceal upper gastro-intestinal bleeding. Baillieres Clin Gastroenterol 144:1384–1393 Crooks CJ, West J, Card TR (2013) Comorbidities affect risk of nonvariceal upper gastro-intestinal bleeding. Baillieres Clin Gastroenterol 144:1384–1393
4.
Zurück zum Zitat Lanas Á et al (2015) Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol 13:906–912CrossRef Lanas Á et al (2015) Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol 13:906–912CrossRef
5.
Zurück zum Zitat Götz M, Anders M, Biecker E et al (2017) S2k-Leitlinie Gastrointestinale Blutung. Z Gastroenterol 55:883–936CrossRef Götz M, Anders M, Biecker E et al (2017) S2k-Leitlinie Gastrointestinale Blutung. Z Gastroenterol 55:883–936CrossRef
6.
Zurück zum Zitat Salvo F, Fourrier-Reglat A, Bazin F et al (2011) Cardiovascular and gastrointestinal safety of NSAIDs: a systematic review of meta-analyses of randomized clinical trials. Clin Pharmacol Ther 89(6):855–866CrossRef Salvo F, Fourrier-Reglat A, Bazin F et al (2011) Cardiovascular and gastrointestinal safety of NSAIDs: a systematic review of meta-analyses of randomized clinical trials. Clin Pharmacol Ther 89(6):855–866CrossRef
7.
Zurück zum Zitat Huang JQ, Sridhar S, Hunt RH (2002) Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet 539:14–22CrossRef Huang JQ, Sridhar S, Hunt RH (2002) Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet 539:14–22CrossRef
8.
Zurück zum Zitat Silverstein FE, Faich G, Goldstein JL (2000) Gastrointestinal toxicity with celecoxib vs nonsteroidal antiinflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. JAMA 284:1247–1255CrossRef Silverstein FE, Faich G, Goldstein JL (2000) Gastrointestinal toxicity with celecoxib vs nonsteroidal antiinflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. JAMA 284:1247–1255CrossRef
9.
Zurück zum Zitat Emery P, Zeidler H, Kvien TK et al (1999) Celecoxib versus diclofenac in long-term management of rheumatoid arthritis: a randomised double-blind comparison. Lancet 354:2106–2111CrossRef Emery P, Zeidler H, Kvien TK et al (1999) Celecoxib versus diclofenac in long-term management of rheumatoid arthritis: a randomised double-blind comparison. Lancet 354:2106–2111CrossRef
10.
Zurück zum Zitat Niculescu L, Huang J, Mallen S (2009) Pooled analysis of GI tolerability of 21 randomized controlled trials of celecoxib and nonselective NSAIDs. Curr Med Res Opin 25:729–740CrossRef Niculescu L, Huang J, Mallen S (2009) Pooled analysis of GI tolerability of 21 randomized controlled trials of celecoxib and nonselective NSAIDs. Curr Med Res Opin 25:729–740CrossRef
11.
Zurück zum Zitat Baraf HSB, Fuentealba C, Greenwald M et al (2007) Gastrointestinal side effects of etoricoxib in patiens with osteoarthritis: results oft he Etoricoxib versus Diclofenac Sodium Gastrointestinal Tolerability and Effectiveness (EDGE) trial. J Rheumatol 34:408–420PubMed Baraf HSB, Fuentealba C, Greenwald M et al (2007) Gastrointestinal side effects of etoricoxib in patiens with osteoarthritis: results oft he Etoricoxib versus Diclofenac Sodium Gastrointestinal Tolerability and Effectiveness (EDGE) trial. J Rheumatol 34:408–420PubMed
12.
Zurück zum Zitat Goldstein JL, Eisen GM, Lewis B et al (2007) Small bowel mucosal injury is reduced in healthy subjects with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol Ther 25:1211–1222CrossRef Goldstein JL, Eisen GM, Lewis B et al (2007) Small bowel mucosal injury is reduced in healthy subjects with celecoxib compared with ibuprofen plus omeprazole, as assessed by video capsule endoscopy. Aliment Pharmacol Ther 25:1211–1222CrossRef
13.
Zurück zum Zitat Laine L, Smith R, Min K et al (2006) Systematic review: the lower gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 24:751–767CrossRef Laine L, Smith R, Min K et al (2006) Systematic review: the lower gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther 24:751–767CrossRef
14.
Zurück zum Zitat Chan FK, Hung LC, Suen BY et al (2002) Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med 347:2104–2110CrossRef Chan FK, Hung LC, Suen BY et al (2002) Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med 347:2104–2110CrossRef
15.
Zurück zum Zitat Chan FK, Wong VW, Suen BY et al (2007) Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial. Lancet 369:1621–1626CrossRef Chan FK, Wong VW, Suen BY et al (2007) Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial. Lancet 369:1621–1626CrossRef
16.
Zurück zum Zitat Fischbach W, Malfertheiner P, Lynen P et al (2016) S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit. Z Gastroenterol 54:327–363CrossRef Fischbach W, Malfertheiner P, Lynen P et al (2016) S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit. Z Gastroenterol 54:327–363CrossRef
17.
Zurück zum Zitat ACTIVE Investigators, Conolly SJ, Pogue J, Hart RG et al (2009) Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 360(20):2066–2078CrossRef ACTIVE Investigators, Conolly SJ, Pogue J, Hart RG et al (2009) Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 360(20):2066–2078CrossRef
18.
Zurück zum Zitat Lanas A, Fuentes J, Benito R et al (2002) Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther 16:779–786CrossRef Lanas A, Fuentes J, Benito R et al (2002) Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther 16:779–786CrossRef
19.
Zurück zum Zitat CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348:1329–1339CrossRef CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348:1329–1339CrossRef
20.
Zurück zum Zitat Serebruany VL, Malinin AI, Ferguson JJ et al (2008) Bleeding risks of combination vs. single antiplatelet therapy: a meta-analysis of 18 randomized trials comparing 129 314 patients. Fundam Clin Pharmacol 22:315–321CrossRef Serebruany VL, Malinin AI, Ferguson JJ et al (2008) Bleeding risks of combination vs. single antiplatelet therapy: a meta-analysis of 18 randomized trials comparing 129 314 patients. Fundam Clin Pharmacol 22:315–321CrossRef
21.
Zurück zum Zitat Wiviott SD, Braunwald E, McCabe CH et al (2007) Triton-TIMI-38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357(20):2001–2015CrossRef Wiviott SD, Braunwald E, McCabe CH et al (2007) Triton-TIMI-38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357(20):2001–2015CrossRef
22.
Zurück zum Zitat Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151CrossRef Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151CrossRef
23.
Zurück zum Zitat Hart RG, Benavente O, McBride R, Pearce LA (1999) Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 131:492–501CrossRef Hart RG, Benavente O, McBride R, Pearce LA (1999) Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 131:492–501CrossRef
24.
Zurück zum Zitat Conolly SJ, Eikelboom J, Joyner C et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364:806–817CrossRef Conolly SJ, Eikelboom J, Joyner C et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364:806–817CrossRef
25.
Zurück zum Zitat Granger CB, Alexander JH, McMurray JJV et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365:981–992CrossRef Granger CB, Alexander JH, McMurray JJV et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365:981–992CrossRef
26.
Zurück zum Zitat Patel MR, Mahaffey KW, Garg J et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365:883–891CrossRef Patel MR, Mahaffey KW, Garg J et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365:883–891CrossRef
27.
Zurück zum Zitat Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151CrossRef Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151CrossRef
28.
Zurück zum Zitat Holster L, Valkhoff VE, Kuipers EJ, Tjwa ETTL (2013) New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 145:105–112CrossRef Holster L, Valkhoff VE, Kuipers EJ, Tjwa ETTL (2013) New oral anticoagulants increase risk for gastrointestinal bleeding: a systematic review and meta-analysis. Gastroenterology 145:105–112CrossRef
29.
Zurück zum Zitat Ruff CT, Giugiano RP, Braunwald E et al (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383:955–962CrossRef Ruff CT, Giugiano RP, Braunwald E et al (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383:955–962CrossRef
31.
Zurück zum Zitat Chan FK, Lanas A, Scheiman J et al (2010) Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet 376:173–179CrossRef Chan FK, Lanas A, Scheiman J et al (2010) Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CONDOR): a randomised trial. Lancet 376:173–179CrossRef
32.
Zurück zum Zitat Hooper L, Brown TJ, Elliott R et al (2004) The effectiveness of five strategies fort he prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic review. BMJ 329:948CrossRef Hooper L, Brown TJ, Elliott R et al (2004) The effectiveness of five strategies fort he prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic review. BMJ 329:948CrossRef
33.
Zurück zum Zitat Denzer U, Beilenhoff U, Eickhoff A et al (2015) S2k-Leitlinie Qualitätsanforderungen in der gastrointestinalen Endoskopie, AWMF Register Nr. 021-022. Z Gastroenterol 53:E1–E227CrossRef Denzer U, Beilenhoff U, Eickhoff A et al (2015) S2k-Leitlinie Qualitätsanforderungen in der gastrointestinalen Endoskopie, AWMF Register Nr. 021-022. Z Gastroenterol 53:E1–E227CrossRef
34.
Zurück zum Zitat Sung JJ, Lau JY, Ching JY et al (2010) Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 152:1–9CrossRef Sung JJ, Lau JY, Ching JY et al (2010) Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 152:1–9CrossRef
35.
Zurück zum Zitat Sengupta N, Feuerstein JD, Patwardhan VR et al (2015) The risks of thromboembolism versus gastrointestinal bleeding after interruption of systemic anticoagulation in hospitalized inpatients with gastrointestinal bleeding: A prospective study. Am J Gastroenterol 110:328–335CrossRef Sengupta N, Feuerstein JD, Patwardhan VR et al (2015) The risks of thromboembolism versus gastrointestinal bleeding after interruption of systemic anticoagulation in hospitalized inpatients with gastrointestinal bleeding: A prospective study. Am J Gastroenterol 110:328–335CrossRef
Metadaten
Titel
Medikamenteninduzierte gastrointestinale Blutung
verfasst von
Prof. Dr. med. W. Fischbach
Publikationsdatum
03.04.2020

Weitere Artikel der Ausgabe 2/2020

coloproctology 2/2020 Zur Ausgabe