Should antithrombotic therapy be stopped in patients undergoing gastric endoscopic submucosal dissection?
Should antithrombotic therapy be stopped in patients undergoing gastric endoscopic submucosal dissection?
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DOI：
10.1007/s00464-016-5167-4
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发表时间：
2017-04-01
影响因子：
3.1
通讯作者：
Ono, Hiroyuki
中科院分区：
文献类型：
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作者：
Igarashi, Kimihiro;Takizawa, Kohei;Ono, Hiroyuki
背景胃内镜黏膜下剥离术（ESD）患者的抗血栓治疗是一个值得关注的问题。本研究旨在评估接受抗血栓治疗的患者胃ESD后迟发性出血的发生率。回顾了2009年1月至2014年10月接受胃ESD的患者。比较接受抗栓治疗的患者与匹配对照组的迟发性出血发生率。我们还比较了继续抗栓治疗患者与肝素桥接或停止抗栓治疗患者的迟发性出血发生率。在2388个胃ESD切除病灶中，367个病灶在抗血栓治疗后被切除，722个病灶被选择作为对照。接受抗栓治疗的患者的病变分为三个亚组：54处病变术前未停止（继续治疗组），37处肝素桥接病变（肝素组），276处病变停止抗血栓治疗结果接受抗栓治疗的患者迟发性出血的发生率明显高于未接受抗栓治疗的患者（9.5%[35/367]对比4.2%[30/722]; p < 0.01）。持续组、肝素组和停止组的延迟出血率分别为9.2%（5/54）、10.8%（4/37）和9.4%（26/276），未观察到显著差异。血栓形成仅发生在停药组（1.6%）。结论接受抗栓治疗的胃ESD患者迟发性出血发生率明显增高。在停止和未停止抗血栓治疗的患者中，迟发性出血发生率无显著差异。为了防止血栓形成，胃ESD不停止可能是可行的。
Background The management of antithrombotic therapy in the patients undergoing gastric endoscopic submucosal dissection (ESD) is of concern. This study aimed to assess delayed bleeding rate after gastric ESD in the patients receiving antithrombotic therapy.Methods This study was a retrospective observational study held in a single institute. The patients undergoing gastric ESD from January 2009 to October 2014 were reviewed. Delayed bleeding rate in the patients receiving antithrombotic therapy was compared with that in matched controls. We also compared delayed bleeding rate in the patients continuing antithrombotic therapy with that in the patients with heparin bridging or cessation of antithrombotic therapy. Among 2388 lesions resected by gastric ESD, 367 lesions were resected in the patients with antithrombotic therapy, and 722 lesions were selected as controls. The lesions in the patients receiving antithrombotic therapy were divided into three subgroups: 54 lesions without preoperative cessation (continuation group), 37 lesions with heparin bridging (heparin group), and 276 lesions with cessation of antithrombotic therapy (cessation group).Results The incidence of delayed bleeding was significantly higher in the patients receiving antithrombotic therapy (9.5 % [35/367] vs. 4.2 % [30/722]; p < 0.01). Delayed bleeding rate in continuation group, heparin group, and cessation group was 9.2 % (5/54), 10.8 % (4/37), and 9.4 % (26/276), respectively, and no significant difference was observed. Thrombosis occurred only in cessation group (1.6 %).Conclusions Delayed bleeding rate associated with gastric ESD is significantly higher in the patients receiving antithrombotic therapy. No significant difference in delayed bleeding rate was observed among patients with and without cessation of antithrombotic therapy. To prevent thrombosis, gastric ESD without cessation may be feasible.