Timing of bleeding and thromboembolism associated with endoscopic submucosal dissection for gastric cancer in Japan
Timing of bleeding and thromboembolism associated with endoscopic submucosal dissection for gastric cancer in Japan
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DOI：
10.1111/jgh.15536
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发表时间：
2021-05-26
影响因子：
4.1
通讯作者：
Fujisaki, Junko
中科院分区：
文献类型：
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作者：
Shiroma, Sho;Hatta, Waku;Fujisaki, Junko
背景与目的本研究旨在揭示早期胃癌（EGC）内镜下粘膜下剥离（ESD）相关出血和血栓栓塞的时机。方法回顾性分析2013年11月至2016年10月期间接受ESD治疗的10320例EGC患者。我们评估了总体出血率及其组间差异。研究了与早期/晚期（截止5天）出血和血栓栓塞频率相关的因素及其与抗血栓药物摄入的关系。结果总体而言，esd术后出血率为4.7% (489/10 320)；esd后出血的中位时间为4天。未服用抗血栓药物组、服用抗血小板药物组、服用抗凝药物组、服用抗血小板药物组和服用抗血小板药物组esd后出血率分别为3.2%、8.7%、15.5%和29.9%。华法林（比值比[OR]， 9.16）、直接口服ACs （OR, 4.16）、慢性肾脏疾病合并血液透析（OR, 2.93）、硫代吡啶（OR, 2.25）、阿司匹林（OR, 1.66）、肿瘤大小bbb30 mm （OR, 1.86）、多发性肿瘤切除（OR, 1.54）、胃下三分之一肿瘤（OR, 1.40）是早期出血的独立危险因素。晚期出血的独立危险因素为直接口服ACs （OR, 7.42）、慢性肾脏疾病伴血液透析（OR, 4.99）、华法林（OR, 3.90）、硫代吡啶（OR, 3.09）、肝硬化（OR, 2.43）、西洛他唑（OR, 1.93）、阿司匹林（OR, 1.92）、缺血性心脏病（OR, 1.77）和男性（OR, 1.65）。有3例（0.03%）血栓栓塞事件（脑梗死2例，短暂性脑缺血发作1例）。结论我们揭示了早期/晚期出血的时机和危险因素，并显示了EGC的血栓栓塞频率与ESD相关。
Background and Aim This study aimed to reveal the timing of bleeding and thromboembolism associated with endoscopic submucosal dissection (ESD) for early gastric cancer (EGC).Methods We retrospectively reviewed 10,320 patients who underwent ESD for EGC during November 2013-October 2016. We evaluated overall bleeding rates and their inter-group differences. Factors associated with early/late (cut-off 5 days) bleeding and thromboembolism frequency and its association with the intake of antithrombotic agents were investigated.Results Overall, the post-ESD bleeding rate was 4.7% (489/10 320); the median time to post-ESD bleeding was 4 days. The post-ESD bleeding rates were 3.2%, 8.7%, 15.5%, and 29.9% in those not taking antithrombotic agents, those taking antiplatelet agents, those taking anticoagulants (ACs), and those taking antiplatelet agents and ACs. Warfarin (odds ratio [OR], 9.16), direct oral ACs (OR, 4.16), chronic kidney disease with hemodialysis (OR, 2.93), thienopyridine (OR, 2.25), aspirin (OR, 1.66), tumor size >30 mm (OR, 1.86), multiple tumors' resection (OR, 1.54), and tumor in the lower third of the stomach (OR, 1.40) were independent risk factors for early bleeding. The independent risk factors for late bleeding were direct oral ACs (OR, 7.42), chronic kidney disease with hemodialysis (OR, 4.99), warfarin (OR, 3.90), thienopyridine (OR, 3.09), liver cirrhosis (OR, 2.43), cilostazol (OR, 1.93), aspirin (OR, 1.92), ischemic heart disease (OR, 1.77), and male sex (OR, 1.65). There were three (0.03%) thromboembolic events (cerebral infarction = 2, transient ischemic attack = 1).Conclusion We revealed the timing of bleeding and risk factors for early/late bleeding and showed the thromboembolism frequency associated with ESD for EGC.