Division of Gastroenterology, Department of Medicine, Mount Sinai Medical Center, New York, NY 10075, USA.
J Clin Gastroenterol. 2011 Mar;45(3):228-33. doi: 10.1097/MCG.0b013e3181eb5efd.
To assess prospectively the bleeding risk attributable to gastroduodenal biopsy in subjects taking antiplatelet medications.
No prospective data exist regarding the bleeding risk attributable to endoscopic biopsy in patients taking antiplatelet agents. A majority of Western endoscopists withdraw antiplatelet agents before upper endoscopy, despite expert guidelines to the contrary.
We performed a prospective, single-blind, randomized study in healthy volunteers participating in a larger study regarding the effect of antiplatelet agents on gastroduodenal mucosal healing. Multiple gastroduodenal biopsies were performed during 2 esophagogastroduodenoscopy in subjects dosed with aspirin enteric-coated 81 mg once daily or clopidogrel 75 mg once daily. Data for endoscopic bleeding, clinical bleeding, blood vessel size, and depth of biopsy in histology specimens were collected.
Four hundred and five antral biopsies and 225 duodenal biopsies were performed during 90 esophagogastroduodenoscopy in 45 subjects receiving aspirin or clopidogrel. Median maximum blood vessel diameter per biopsy was 31.9 μ (range: 9.2 to 133.8). About 50.8% of biopsy specimens breached the muscularis mucosa. In the clopidogrel group, no bleeding events were noted after 350 biopsies [upper confidence limit (UCL) for probability of bleeding=0.0085]. In the aspirin group, there were no clinical events (UCL=0.0106) and one minor endoscopic bleeding event (UCL=0.0169).
Consistent with expert guidelines, the absolute risk attributable to gastroduodenal biopsy in adults taking antiplatelet agents seems to be low. Half of routine biopsies enter submucosa. The largest blood vessels avulsed during biopsy correspond to midsized and large arterioles and venules.
前瞻性评估服用抗血小板药物的受试者胃十二指肠活检的出血风险。
目前尚无关于服用抗血小板药物患者内镜活检出血风险的前瞻性数据。尽管专家指南有相反的建议，但大多数西方内镜医生在上消化道内镜检查前会停用抗血小板药物。
我们在参加一项关于抗血小板药物对胃十二指肠黏膜愈合影响的更大研究的健康志愿者中进行了一项前瞻性、单盲、随机研究。在服用阿司匹林肠溶片 81mg 每日一次或氯吡格雷 75mg 每日一次的受试者中，进行了两次食管胃十二指肠镜检查，共进行了多次胃十二指肠活检。收集内镜下出血、临床出血、血管大小和组织学标本活检深度的数据。
在 45 名接受阿司匹林或氯吡格雷治疗的受试者中，90 次食管胃十二指肠镜检查共进行了 405 个胃窦活检和 225 个十二指肠活检。每例活检的最大血管直径中位数为 31.9μm（范围：9.2 至 133.8μm）。约 50.8%的活检标本突破了黏膜肌层。在氯吡格雷组，350 次活检后未发生出血事件[出血概率的上限置信区间（UCL）=0.0085]。在阿司匹林组，无临床事件（UCL=0.0106）和 1 例轻微内镜下出血事件（UCL=0.0169）。
与专家指南一致，服用抗血小板药物的成年人胃十二指肠活检的绝对风险似乎较低。常规活检有一半进入黏膜下层。活检时撕裂的最大血管对应于中等大小和大的小动脉和小静脉。
