胃ESD期间在低血栓风险患者中继续服用低剂量阿司匹林:随机试验
Noriya Uedo1, Takuji Gotoda2, Kohei Takizawa3
1Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka.
The American journal of gastroenterology
|January 22, 2026
概括
在低血栓风险患者的胃内镜下粘膜解剖 (ESD) 期间持续服用低剂量阿司匹林 (LDA) 并非低于停止治疗的出血风险. 建议停止LDA以确保胃ESD程序期间的患者安全.
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:
- 低剂量阿司匹林 (LDA) 的使用是常见的心血管预防.
- 对于早期胃癌 (EGC) 进行内镜下粘膜剖析 (ESD) 的周边手术期间停止LDA是有争议的.
- 在低血栓形成风险患者的胃ESD期间持续LDA的安全性需要澄清.
研究的目的:
- 评估是否继续使用LDA与停止使用LDA相比,在ESD相关重大出血风险方面没有劣势.
- 评估在胃ESD期间持续抗血小板作用的安全性,在低血栓形成风险的患者中.
主要方法:
- 进行了一项随机对照试验,对患者进行了胃ESD,用于粘膜瘤和LDA的低血栓风险.
- 参与者被分配到停用LDA或继续使用的组.
- 主要终点是与ESD相关的大型出血的发生率.
主要成果:
- 大型出血的发生率在停药组为7.6%,在继续治疗组为10%.
- 持续使用LDA并未被发现与停止使用LDA不相差,因为90%置信区间的上限超过了非劣势率.
- 继续治疗组中的两名患者经历了脑梗塞.
结论:
- 在低血栓形成风险患者的胃ESD期间继续使用LDA,与停止治疗相比,对出血风险的非劣势性没有被证明.
- 在这种患者群体中,建议在胃ESD的周围手术期间停止LDA.
- 可能需要进一步的研究来探索替代的抗血小板策略.
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