Continuous aspirin use does not increase post-endoscopic dissection bleeding risk for gastric neoplasms in patients on antiplatelet therapy.
Continuous aspirin use does not increase post-endoscopic dissection bleeding risk for gastric neoplasms in patients on antiplatelet therapy.
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DOI：
10.1055/s-0034-1390764
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发表时间：
2015-02
影响因子：
2.6
通讯作者：
Hosono T
中科院分区：
文献类型：
--
作者：
Tounou S;Morita Y;Hosono T
背景和研究目的：内镜手术前停用所有抗血小板药物可能会导致某些患者出现严重并发症。本研究的目的是评价接受抗血小板治疗（APT）的患者内镜下粘膜下剥离术（ESD）后的出血风险。 患者和方法：受试者为2007年1月至2013年7月期间接受胃ESD的350例患者（377处病变）。根据抗血小板治疗对患者进行分类。主要结局为ESD后出血。进行多变量分析，以确定ESD后出血的独立风险因素。 结果如下：患者分为三组：（1）无APT，261例患者，281处病变;（2）单次APT，58例患者，63处病变（53例患者使用低剂量阿司匹林[LDA]，5例患者使用噻吩并吡啶）;和（3）双重APT（DAPT），31例患者，33处病变（DAPT使用LDA和噻吩并吡啶）。无APT组261例患者中有16例（6.1%）、单APT组58例患者中有9例（15.5%）和DAPT组31例患者中有11例（35.5%）发生ESD后出血。 在无APT和单APT组中采用考克斯比例风险模型进行的多变量分析中，APT（HR 2.7，95% CI 1.1 - 6.6，P = 0.03）和切除标本直径≥ 40 mm（HR 2.7，95% CI 1.2 - 5.9，P = 0.01）是ESD后出血的显著风险因素。 在无APT和DAPT组的多变量分析中，DAPT是ESD后出血的唯一显著风险因素（HR 16.3，95%CI 3.4 - 78.2，P <0.01）。 在两项分析中，连续LDA不是ESD后出血的显著风险因素（无APT和单次APT组HR 0.8，95% CI 0.2 - 3.6，P =0.72;无APT和DAPT组HR 1.0，95% CI 0.2 - 5.1，P =0.95）。 结论：APT增加了ESD后出血的风险，DAPT显著增加了出血的风险。在所有接受APT治疗的患者中，连续LDA未产生额外的出血风险。因此，应仔细监测接受APT治疗的患者的ESD后出血情况，对于血栓栓塞风险较高的患者，不应中断LDA。
Background and study aims: Discontinuation of all antiplatelet agents before endoscopic procedures may cause serious complications in some patients. The aim of this study was to evaluate the hemorrhagic risk of post-endoscopic submucosal dissection (ESD) in patients on antiplatelet therapy (APT). Patients and methods: The subjects were 350 patients (377 lesions) who underwent gastric ESD between January 2007 and July 2013. The patients were categorized based on antiplatelet therapies. The primary outcome was post-ESD bleeding. Multivariate analysis was performed to identify independent risk factors for post-ESD bleeding. Results: The patients were categorized into three groups: (1) no APT, 261 patients with 281 lesions; (2) single APT, 58 patients with 63 lesions (53 patients with low dose aspirin [LDA] and 5 patients with a thienopyridine); and (3) dual APT (DAPT), 31 patients with 33 lesions (DAPT with LDA and a thienopyridine). Post-ESD bleeding occurred in 16 of 261 patients in the no APT group (6.1 %), 9 of 58 patients in the single APT group (15.5 %), and 11 of 31 patients in the DAPT group (35.5 %). In multivariate analysis with a Cox proportional hazards model in the no APT and single APT groups, APT (HR 2.7, 95 %CI 1.1 – 6.6, P = 0.03) and diameter of the resected specimen of 40 mm or greater (HR 2.7, 95 %CI 1.2 – 5.9, P = 0.01) were significant risk factors for post-ESD bleeding. In multivariate analysis in the no APT and DAPT groups, DAPT was the only significant risk factor for post-ESD bleeding (HR 16.3, 95 %CI 3.4 – 78.2, P < 0.01). Continuous LDA was not a significant risk factor for post-ESD bleeding in both analyses (HR 0.8, 95 %CI 0.2 – 3.6, P = 0.72 in the no APT and single APT groups; HR 1.0, 95 %CI 0.2 – 5.1, P = 0.95 in the no APT and DAPT groups). Conclusions: APT increased the risk for post-ESD bleeding, and DAPT markedly increased the risk for bleeding. Continuous LDA did not produce an additional hemorrhagic risk in all patients treated with APT. Thus, patients treated with APT should be careful monitored for post-ESD bleeding, and LDA should not be interrupted in patients with a high thromboembolic risk.