在直接使用口服抗凝剂的患者中,胃内镜后的下粘膜切割出血的危险因素
Tomo Kagawa1, Shigenao Ishikawa1, Yu Hidaka2
1Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan.
概括
直接口服抗凝剂 (DOACs) 在胃内镜下粘膜切割 (ESD) 后增加出血风险. 与其他DOAC相比,达比加特兰的出血风险相对较小,中性粒细胞透也是一个关键的风险因素.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 内镜下粘膜切割 (ESD) 是胃瘤的治疗方法.
- 在服用抗血栓性药物,特别是直接口服抗凝剂 (DOACs) 的患者中,ESD后出血是一个重大问题.
- 风险因素和ESD后出血的药物特异性差异需要进一步调查.
研究的目的:
- 评估服用抗血栓药物患者ESD后出血的危险因素.
- 为了比较与胃ESD后不同类型的DOAC相关的出血风险.
主要方法:
- 在2017年1月至2022年3月期间,对278名接受胃ESD的患者进行了回顾性研究.
- 抗血栓性药物戒断遵循了2017年的指导方针.
- 多变量分析评估了出血风险因素,包括对周围癌性粘膜的病理评估.
主要成果:
- DOAC与ESD后出血风险更高相关 (OR 4.92).
- 在DOAC使用者的出血风险因素包括大切除直径 (≥30毫米),中性粒细胞透,下胃病变和术前抗血小板使用.
- 根据DOAC类型的出血率有所不同:阿皮克萨班 (25.0%),埃多克萨班 (20.0%),里瓦罗克萨班 (21.4%),达比加特兰 (0%).
结论:
- DOAC的使用是ESD后出血的危险因素.
- 中性粒细胞的透是DOAC使用者的重要危险因素.
- 与其他DOAC相比,达比加特兰似乎与胃ESD后出血风险较低有关.
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