Prevention and management of bleeding in cerebral infarction treated with antiplatelet/anticoagulant drugs combined with cefoperazone sulbactam in elderly patients
Objective To investigate the risk factors and management of bleeding in elderly patients with cerebral infarction treated with antiplatelet/anticoagulant(anti-PLT/CGL)and cefoperazone sulbactam(CP-SB).Methods Analysis was conducted for 5 cases of senile cerebral infarction treated with anti-PLT/CGL drugs combined with CP-SB to explore the mechanism of hem-orrhage induced by combined medication in elderly patients and its countermeasures.Results The 5 patients were at high risk for bleeding,all of whom were over 75 years of age and had a history of two anti-PLT/CGL combinations.In case 1 and case 3,aspirin enteric-coated tablets were administered by gastric tube after crushing,which was the key factor causing gastrointestinal bleeding.The history of lower gastrointestinal bleeding in case 1,steroid use in case 2 and case 4,and reserpine use in case 5 were all high risk factors for gastrointestinal bleeding.In case 4 and case 5,the combination of antiplatelet and anticoagulant drugs increased the risk of bleeding.All of the 5 patients were treated with CP-SB.Of the 5 patients,3 had abnormal coagulation function and 1 low platelet count and the abnormal indicators refer to coagulation and markers of platelet abnormalities were gradually corrected when CP-SB was replaced.The high dose(case 2 and case 5,3 g every time,q8h)and long course(12 days in case 1,17 days in case 3,14 days in case 5)of treatment of CP-SB strengthened the inhibition of intestinal flora and deepened the harmful influence on blood coagula-tion.Meanwhile,the history of megaloblastic anemia in case 3 and the use of anti-PLT/CGL in all patients were high risk factors for bleeding.Conclusion The adverse reactions,especially the bleeding events,should be paid attention to when the elderly patients with cerebral infarction were treated with anti-PLT/CGL.Furthermore,the advantages and disadvantages of the combination therapy should be re-evaluated according to the physiopathological status of the elderly patients.When necessary,preventive measures can be taken to reduce the risk of bleeding,and nursing care can improve patients'discrimination of early bleeding and reduce the incidence of rebleeding.
Senile cerebral infarctionAntiplatelet/anticoagulantCefoperazone sulbactamBleedingCoagulation function
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维普
