Aspirin, clopidogrel (the original research is called "Bolivar", generic drugs have "Taijia", etc.), patients with coronary heart disease and cerebrovascular disease are very familiar with it, and they eat it for a long time!
Why eat, to resist platelets. Because these patients, platelets are more active than others, easy to "grow thrombosis", so to resist.
However, since it is antiplatelet and prevents long blood clots, the chance of bleeding is also more. Therefore, patients taking antiplatelet drugs should pay attention to prevent bleeding.
Bleeding can be in various parts, skin, mucous membranes, gastrointestinal tract, urinary tract, and so on. Therefore, when persuading the medicine, we should pay attention to prevent bumps, observe whether there is obvious bleeding on the body, and how to defecate.
Blood occult in the stool. As soon as you hear the word submersible blood, you have this meaning, potential blood. Positive fecal occult blood, suggesting a potential blood component in the stool. The appearance of the stool can be normal in color, and red blood cells cannot be seen under the microscope, but the chemical reaction can be detected.
The amount of blood that can produce positive fecal occult blood can be very small, and 5 ml of blood is enough. So this method can detect a small amount of blood components in the stool, and can find bleeding in the digestive tract. Earlier methods of testing occult blood are susceptible to interference with animal blood and other components in food, and false positives are more frequent. Now it is a special test for human blood, which is much more accurate and not easy to be interfered with.
Therefore, a positive fecal occult blood indicates that there is bleeding in the digestive tract.
So, people who eat antiplatelet drugs, the stool has a positive occult blood, is it an adverse drug reaction?
Don't equate it like that.
It is true that antiplatelet drugs may cause gastrointestinal bleeding, but gastrointestinal bleeding has many causes. "Long things", polyps, tumors, is a very important reason that cannot be ignored.
Say a case. We have met quite a few of these patients before this, and this is recently encountered.
An old man in his late 80s, coronary heart disease, cerebrovascular disease, long-term eating clopidogrel, 20 years younger.
Recently, I had to go through a physical examination, checked the stool routine and occult blood, and found that the fecal occult blood was "positive". Re-examine, weak positive; re-examination, again positive. Come to me.
The stool looks normal, and no red blood cells are seen on microscopic examination, not like hemorrhoidal bleeding. Hemorrhoid bleeding, will be blood on the surface of the stool, blood, generally after the stool is obvious, red blood cells can be seen under the microscope.
I suggested she go for a gastrointestinal endoscopy.
After a week's pause in clopidogrel, she went to get her test.
Examination revealed stomach polyps and a "mass lesion" in the transverse colon. Mass lesions, lesions encroaching on the position of normal tissues, the nature of which is unclear. Generally speaking, such a description is mostly about tumors, malignant tumors.
There is also an episode here where the patient also eats a drug for the treatment of varicose veins, "Mai Zhi Ling". Because I didn't feel that this drug had any effect at that time, I didn't stop taking it. As a result, the doctor who did the endoscopy did not dare to take the biopsy (biopsy). Because doctors have encountered cases of taking "Mai Zhi Ling" for biopsy and causing heavy bleeding due to poor blood clotting function. The patient came back and told me that I had also grown in knowledge.
Originally, the endoscopic doctor also wanted to take another colonoscopic biopsy after stopping the drug. Surgical experts look at the gastroscopy report, don't take the biopsy, seize the time to do the operation.
In this way, I was hospitalized for surgery.
The results of the surgery were unsurprising, colon cancer of the transverse colon.
Afterwards, the patient's friend asked me, didn't it mean that colon cancer would obstruct and change? The patient's colon cancer has been narrowed, how can the stool still look normal?
Because in the transverse colon area, the stool is still relatively thin and no fecal mass is formed, so the intestinal obstruction will appear relatively late. This is not good, it is not easy to detect early.
Some people will think, almost 80 years old, what else to do surgery?
If colon cancer can be surgically removed and there is no metastasis, the consequences are still very good. And even if there are other problems, surgical resection can at least relieve the intestinal obstruction and make the patient's quality of life better later. Moreover, the removal of the primary tumor lesion is also beneficial to later treatment. Therefore, if you can operate, you still have to operate, otherwise the risk of surgery is higher if the acute obstruction is done.
Saying this case is to remind you that gastrointestinal bleeding occurs while eating antiplatelet drugs, you must not just think about the side effects of the drug, you must pay attention to excluding other lesions of the digestive tract.
There is also a little knowledge that before gastrointestinal endoscopy, you must also stop taking the "Mai Spirit".
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Department of Cardiology Hou Xiaoping