Evaluation of safety of endoscopic biopsy without cessation of antithrombotic agents in Japan
Evaluation of safety of endoscopic biopsy without cessation of antithrombotic agents in Japan
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DOI：
10.1007/s00535-012-0538-7
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发表时间：
2012-07-01
影响因子：
6.3
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Ono, Satoshi;Fujishiro, Mitsuhiro;Koike, Kazuhiko
背景尽管日本指南建议在内镜活检前停用抗血栓药物，但迄今为止，日本尚未对不停用这些药物的活检安全性进行评估。因此，我们的目的是评估活检的可行性，而不停止抗血栓药物在Japanes.Methods这是一个前瞻性的单臂研究，从一个单一的机构。从2010年5月至2011年11月，入组了112例因血栓栓塞事件的高风险状态（冠状动脉支架植入后、瓣膜置换后或既往有血栓栓塞事件或房颤所致心力衰竭病史）而接受抗血栓形成药物的门诊患者。我们评估了严重出血并发症的发生率在2周内内镜检查和内镜下出血时间（EBT）活检后的患者进行活检的内镜检查结果需要病理assessment.Results的112名参与者中，101活检进行了48和12个门诊病人有食管胃镜检查和结肠镜检查，分别。所有的活检标本都提供了足够的病理学评价。在内窥镜观察期间，所有活检均证实了活检后止血。在活检后2周观察期内，无患者主诉任何出血症状（0/101; 95%置信区间[CI] 0-3.6%）。关于EBT（中位数2.2 ± 1.8分钟，范围0.5-9分钟），接受单一抗血栓药物的患者与接受多种药物的患者之间无显著差异（2.4 +/- 1.4 vs. 2.1 +/- 2.1 min），未接受华法林治疗的患者与接受华法林治疗的患者之间也没有任何显著差异（2.3 +/- 1.8 vs. 2.2 +/- 1.8 min）.结论在西方指南中推荐的不停用抗血栓药物的情况下进行活检，如果仔细进行，对于日本人来说也是可以接受的。
Background Although guidelines in Japan recommend the cessation of antithrombotic agents before endoscopic biopsy, the safety of biopsy without the cessation of these agents has not been evaluated to date in this country. Therefore, we aimed to assess the feasibility of biopsy without cessation of antithrombotic agents in Japan.Methods This was a prospective single-arm study from a single institution. From May 2010 to November 2011, 112 outpatients who were receiving antithrombotic agents because of their high-risk status for a thromboembolic event (after implantation of coronary stent, after valve replacement, or a previous history of thromboembolic event or heart failure due to atrial fibrillation) were enrolled. We evaluated the rate of severe bleeding complications within 2 weeks after endoscopy and the endoscopic bleeding time (EBT) after biopsy in patients who underwent biopsy for endoscopic findings requiring pathology assessment.Results Among the 112 participants, 101 biopsies were performed for 48 and 12 outpatients who had had esophagogastroduodenoscopy and colonoscopy, respectively. All the biopsies provided enough specimens to evaluate pathologically. Hemostasis after biopsy was confirmed for all biopsies during endoscopic observation. No patients complained of any bleeding symptoms in the 2-week observation period after biopsy (0/101; 95% confidence interval [CI] 0-3.6%). Concerning the EBT (median 2.2 +/- 1.8 min, range 0.5-9 min), there were no significant differences between patients receiving single antithrombotic agents and those receiving multiple agents (2.4 +/- 1.4 vs. 2.1 +/- 2.1 min), nor were there any significant differences between patients not receiving and receiving warfarin (2.3 +/- 1.8 vs. 2.2 +/- 1.8 min).Conclusion Biopsy without cessation of antithrombotic agents, as recommended in Western guidelines, can also be acceptable for Japanese people if performed carefully.