THE INFLUENCE OF FIBRINOLYTIC AND HEPARIN THERAPY IN ACUTE MYOCARDIAL INFARCTION UPON GASTROINTESTINAL BLEEDING IN PATIENTS WITH ASYMPTOMATIC ULCEROUS DISEASE
Autori:
Davor Horvat, Igor Francetić
Sažetak
Sažetak. Svrha rada: utvrditi učestalost hematemeze i melene (H/M) kod asimptomatskih ulkusnih bolesnika kao komplikacije fibrinolitičke i heparinske terapije u akutnom infarktu miokarda sa ST-elevacijom (STEMI). Metode: bolesnici sa STEMI-em su prema terapiji heparinom ili streptokinazom bili podijeljeni u dvije skupine, a svaka je skupina imala ispitivanu podskupinu s asimptomatskim ulkusnim bolesnicima i kontrolnu podskupinu s bolesnicima bez ulkusne bolesti. Rezultati: kod heparinske terapije nije bilo značajnijeg povećanja H/M u bolesnika s ulkusnom bolesti i bez nje (3,4 vs 2,8%, n.s.), a isto tako ni kod fibrinolitičke terapije (5,9 vs 6,8%, n.s.). Fibrinolitička terapija uzrokuje više H/M u odnosu na heparinsku terapiju kod ulkusnih bolesnika (5,9 vs 3,4%; 2=6,389; p=0,011), ali i bolesnika bez ulkusne bolesti (6,8 vs 2,8%; 2=6,16; p=0,013). Kod bolesnika s H/M bilo je nesignifikantno više žena (42,4% vs 57,6%, n.s.). Zaključak: asimptomatski ulkusni bolesnici mogu dobivati fibrinolitičku i heparinsku terapiju u liječenju STEMI-a bez značajnijeg rizika od pojave H/M u odnosu na bolesnike bez ulkusne bolesti.
Summary
Summary. Aim. To determine in patients with asymptomatic ulcerous disease frequency of hemathemesis and melena (H/M) as complications of fibrinolytic and heparin therapy in acute ST-elevation myocardial infarction (STEMI). Methods. According to heparin and streptokinase therapy, STEMI patients were divided into two groups. Each group consisted of case study subgroup with patients who had asymptomatic ulcerous disease and a control study subgroup with patients who did not have ulcerous disease. Results. In heparin therapy there was no significant increase of H/M in patients with and without ulcerous disease (3.4% vs 2.8%, n.s.) as well as in fibrinolytic therapy (5.9% vs 6.8%, n.s.). Fibrinolytic therapy causes more H/M in relation to heparin therapy in patients with ulcerous disease (5.9 vs 3.4%; 2=6.389; p=0.011) as well as in patients without ulcerous disease (6.8 vs 2.8%; 2=616; p=0.013). In patients with H/M there were insignificantly more women than men (42.4% vs 57.6%, n.s.). Conclusion. Patients with asymptomatic ulcerous disease can be exposed to fibrinolytic and heparin therapy when treating STEMI without a significant risk to H/M occurrence in relation to patients without ulcerous disease.
