抗血栓治療を受けている患者の食道拡張の手続きの安全性: 米国共同ネットワークコホート研究
Khaled Elfert1, Abdellatif Ismail2, Mohammed Abusuliman3
1Division of Gastroenterology, West Virginia University School of Medicine, Morgantown, WV, USA.
The American journal of gastroenterology
|August 20, 2025
まとめ
抗凝固剤を服用している患者では,食道が膨張すると胃腸出血のリスクが高くなります. 二重抗血小板治療は,統計的に有意ではないが,出血の増加傾向を示した.
科学分野:
- 胃腸内科
- 心臓病科
- 臨床医学
背景:
- 抗血栓薬を使用する患者では食道膨張が一般的です.
- 食道膨張中の抗血栓療法に関連した出血のリスクはよく定義されていません.
研究 の 目的:
- 抗凝固剤または二重抗血小板療法 (DAPT) を受けている患者における術後の胃腸出血のリスクを評価する.
主な方法:
- TriNetX US Collaborative Networkのデータベースを用いた後向きにマッチしたコホート研究.
- 食道拡張後30日間の胃腸出血に対する抗凝固剤とDAPTの効果を評価した.
主要な成果:
- 抗凝固剤の使用は,手術後の胃腸出血 (RR,1. 43;95%CI,1. 06-1. 92) のリスクを有意に増加させ,輸血およびICU入院率が高まった.
- 二重抗血小板療法 (DAPT) は,数値的に高度の腸内出血 (RR,1. 64; 95% CI,0. 97- 2. 75) を示したが,これは統計的に有意ではなかった.
- 早期に抗血栓治療を再開すると,出血のリスクは増加しなかった.
結論:
- 抗凝固剤治療は食道拡張後の出血のリスクが高くなります.
- DAPTは出血リスクを増加させる可能性があるが,統計的有意性を確認するにはさらなる研究が必要である.
- 発見は食道拡張の手続きに関する抗血栓管理に関する臨床的決定を導くことができます.
関連する概念動画
Endoscopic Procedures I: Esophagogastroduodenoscopy
348
An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
During an EGD, the endoscope can be used to:
During an EGD, the endoscope can be used to:
348
Esophageal Strictures-II: Clinical Features and Management
157
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
157
Esophageal Varices-II: Clinical Features and Management
139
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
139
Esophageal Varices-I: Introduction
333
Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
333
Esophageal Strictures-I: Introduction
267
Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
267
Aneurysm IV: Nursing Management
20
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
20


