Per-oral endoscopic myotomy in patients with antithrombotic agents: a large-scale multicenter study in Japan Journal
Per-oral endoscopic myotomy in patients with antithrombotic agents: a large-scale multicenter study in Japan Journal
复制标题
抗血栓药物患者的经口内窥镜肌切开术：日本杂志上的一项大规模多中心研究
DOI：
10.1111/jgh.15708
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发表时间：
2021
影响因子：
4.1
通讯作者：
Haruhiro Inoue
中科院分区：
文献类型：
--
作者：
Yuto Shimamura;Hiroki Sato;Manabu Onimaru;Shinwa Tanaka;Hironari Shiwaku;Junya Shiota;Chiaki Sato;Ryo Ogawa;Hiroshi Yokomichi;Haruhiro Inoue
背景和目的：对于接受抗血栓治疗的患者，经口内镜下肌切开术的围手术期管理和临床过程仍然未知。本研究旨在阐明经口内镜下肌切开术中抗血栓治疗的现状，并确定其安全性和有效性。回顾性研究了2010年至2019年在日本7个高容量中心接受经口内镜下肌切开术治疗的患者。患者的特点和抗血栓药物的管理进行了分析，临床结果进行了比较，与那些没有抗血栓agents.ResultsOf 2752例患者进行经口内镜下肌切开术，120例抗血栓治疗（平均年龄71.0岁，美国麻醉医师学会分级II-IV [67.5%]）被确定。分别有82例、30例和8例患者使用了抗血小板、抗凝剂和抗血栓药物联合治疗。大多数患者（88.3%）的围手术期处理遵循日本胃肠病内镜学会发布的治疗性内镜指南。在接受抗血栓治疗的贲门失弛缓症患者中，临床基线状态较差（美国麻醉医师协会II-IV级; 67.0%比24.3%）和乙状结肠型（40.7%比22.3%）更常见。然而，临床成功率（Eckardt评分≤ 3; 97.6%vs94.6）和不良事件发生率（如出血和血栓栓塞事件（5.5%vs4.7%））并未显示出劣效性。但是，需要谨慎，因为接受抗血栓治疗的患者的基线健康状况和贲门失弛缓症状态往往较差。我们的经验应有助于建立围手术期管理与抗血栓治疗。
Background and AimThe perioperative management and clinical course of per‐oral endoscopic myotomy for patients receiving antithrombotic therapy remains unknown. This study aimed to clarify the status of antithrombotic therapy in per‐oral endoscopic myotomy and to determine its safety and efficacy.MethodsPatients treated with per‐oral endoscopic myotomy from 2010 to 2019 in seven high‐volume centers in Japan were retrospectively investigated. The patients' characteristics and antithrombotic agent management were analyzed; clinical outcomes were compared with those without antithrombotic agents.ResultsOf 2752 patients who underwent per‐oral endoscopic myotomy, 120 patients on antithrombotic therapy (mean age 71.0 years, American Society of Anesthesiologists class II–IV [67.5%]) were identified. Antiplatelet, anticoagulant, and a combination of antithrombotic agents were used in 82, 30, and 8 patients, respectively. The perioperative management adhered to the therapeutic endoscopy guidelines published by the Japanese Society of Gastroenterological Endoscopy in most patients (88.3%). A poorer clinical baseline status (American Society of Anesthesiologists class II–IV; 67.0%vs24.3%) and the sigmoid type (40.7%vs22.3%) were more frequently observed in patients with achalasia on antithrombotic therapy. However, the clinical success (Eckardt score ≤ 3; 97.6%vs94.6) and adverse event rates, such as bleeding and thromboembolic events (5.5%vs4.7%), did not show inferiority.ConclusionsPer‐oral endoscopic myotomy on antithrombotic therapy is safe and effective. However, caution is required as patients on antithrombotic therapy tend to have poorer baseline health and achalasia statuses. Our experience should help establish perioperative management with antithrombotic therapy.