结肠直肠内镜粘膜切除与持续抗凝剂治疗期间出血风险:一个多中心研究
Sayo Kobayashi1, Keita Harada2,3, Toru Nawa1
1Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, JPN.
Cureus
|February 3, 2025
概括
在结直肠癌的内镜粘膜切除 (EMR) 期间继续服用口服抗凝剂是安全的,主要出血率为4.7%. 这种方法是氨酸桥梁的可行替代方案,最大限度地降低出血和血栓形成的风险.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 心脏病学 心脏病学
背景情况:
- 内镜粘膜切除 (EMR) 对于预防结直肠癌至关重要.
- 在EMR期间使用抗凝剂的患者的管理是由于出血和血栓形成风险而面临的挑战.
- 目前的指导方针倾向于继续使用抗凝剂而不是使用肝素弥合剂,但出血数据有限.
研究的目的:
- 为了评估在继续服用口服抗凝药时接受EMR的患者的出血率.
- 为了比较华法林和直接口服抗凝剂 (DOAC) 之间的出血风险.
- 评估持续抗凝血的安全性,作为氨酸桥接的替代方案.
主要方法:
- 一项多中心前性研究招募了107名在12家三级医院接受EMR的患者.
- 在EMR的一天,患者继续服用华法林或暂时暂停直接口服抗凝剂 (DOACs).
- 严重出血被定义为需要难以静血或内镜干预的出血;不良事件被监测了30天.
主要成果:
- 严重出血发生在4.7%的患者中,所有病例都通过内镜治疗.
- 轻微出血和血栓塞栓事件分别发生在7.5%和0.9%的患者中.
- 华法林和DOAC之间没有观察到出血率的显著差异.
结论:
- 在EMR期间继续服用口服抗凝剂与较低的大型出血率 (4.7%) 有关.
- 这一策略表明,与肝素桥接相比,它具有有利的安全性.
- 这些发现支持继续抗凝药作为EMR患者的安全替代方案.
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