抗凝患者的结肠镜息肉切除术。
Colonoscopic polypectomy in anticoagulated patients.
作者信息
Friedland Shai, Sedehi Daniel, Soetikno Roy
机构信息
Division of Gastroenterology, VA Palo Alto and Stanford University, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
出版信息
World J Gastroenterol. 2009 Apr 28;15(16):1973-6. doi: 10.3748/wjg.15.1973.
AIM
To review our experience performing polypectomy in anticoagulated patients without interruption of anticoagulation.
METHODS
Retrospective chart review at the Veterans Affairs Palo Alto Health Care System. Two hundred and twenty five polypectomies were performed in 123 patients. Patients followed a standardized protocol that included stopping warfarin for 36 h to avoid supratherapeutic anticoagulation from the bowel preparation. Patients with lesions larger than 1 cm were generally rescheduled for polypectomy off warfarin. Endoscopic clips were routinely applied prophylactically.
RESULTS
One patient (0.8%, 95% CI: 0.1%-4.5%) developed major post-polypectomy bleeding that required transfusion. Two others (1.6%, 95% CI: 0.5%-5.7%) had self-limited hematochezia at home and did not seek medical attention. The average polyp size was 5.1 +/- 2.2 mm.
CONCLUSION
Polypectomy can be performed in therapeutically anticoagulated patients with lesions up to 1 cm in size with an acceptable bleeding rate.
目的
回顾我们在不中断抗凝治疗的情况下为抗凝患者进行息肉切除术的经验。
方法
在退伍军人事务部帕洛阿尔托医疗保健系统进行回顾性病历审查。对123例患者进行了225次息肉切除术。患者遵循标准化方案，包括停用华法林36小时，以避免肠道准备导致抗凝作用过强。对于病变大于1厘米的患者，通常重新安排在停用华法林后进行息肉切除术。常规预防性应用内镜夹。
结果
1例患者（0.8%，95%可信区间：0.1%-4.5%）发生息肉切除术后大出血，需要输血。另外2例患者（1.6%，95%可信区间：0.5%-5.7%）在家中出现自限性便血，未就医。息肉平均大小为5.1±2.2毫米。
结论
对于病变大小达1厘米的接受治疗性抗凝的患者，息肉切除术可以在可接受的出血率下进行。
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