诺普拉桑或质子抑制剂用于胃内镜下粘膜解剖在服用抗血栓剂的患者
Hiroyuki Shibata1, Toshihisa Fujiyoshi2, Noboru Kawata3
1Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan.
Journal of gastroenterology and hepatology
|May 27, 2025
概括
诺普拉桑 (VPZ) 在服用抗血栓剂的患者中,在胃内镜下粘膜解剖 (ESD) 后预防延迟出血方面没有证明优于质子抑制剂 (PPI). 这两种治疗方法在这个患者群体中表现出类似的疗效和安全结果.
科学领域:
- 胃肠病学 胃肠病学
- 内镜检查是指内镜检查.
- 药理学 药理学是指药理学的学科.
背景情况:
- 延迟出血是胃内镜下粘膜解剖 (ESD) 后的一个重要并发症.
- 接受ESD的患者通常需要抗血栓剂,增加术后出血的风险.
- 目前的管理策略旨在减轻这种风险,但最佳药物治疗仍在研究中.
研究的目的:
- 为了比较vonoprazan (VPZ) 与质子抑制剂 (PPI) 在预防胃ESD后延迟出血的疗效.
- 评估二次结果,包括愈,症状发生率和安全性.
主要方法:
- 一个多中心的,开放的,随机对照试验,涉及119名接受胃ESD并服用抗血栓剂的患者.
- 随机分配患者接受VPZ (20毫克/天) 或埃索梅普拉 (20毫克/天) 8周.
- 主要终点是ESD后8周内延迟出血的比率.
主要成果:
- 延迟出血率在VPZ组为13.6%,在PPI组为8.3%,没有统计学上显著的差异 (p=0.36).
- 在VPZ和PPI组之间,愈率,症状发生率和不良事件是可比的.
- 与延迟出血相关的因素包括每天不使用抗酸药和联合抗血小板和抗凝剂治疗.
结论:
- 在服用抗血栓剂的患者中,诺普拉桑 (VPZ) 在预防胃ESD后延迟出血方面并不优于质子抑制剂 (PPI).
- 在这种情况下,VPZ和PPI都显示出可比的安全性和有效性.
- 进一步的研究可能会探索特定的患者子组或替代的管理策略.
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