双联抗血小板治疗患者的胆胰内镜及外科手术：一项单中心研究
Biliary-Pancreatic Endoscopic and Surgical Procedures in Patients under Dual Antiplatelet Therapy: A Single-Center Study.
作者信息
Abdel Samie Ahmed, Stumpf Michael, Sun Rui, Theilmann Lorenz
机构信息
Department of Gastroenterology, Pforzheim Hospital, Pforzheim, Germany.
出版信息
Clin Endosc. 2013 Jul;46(4):395-8. doi: 10.5946/ce.2013.46.4.395. Epub 2013 Jul 31.
Abstract
BACKGROUND/AIMS: Dual antiplatelet therapy has to be used for at least 1 month after placement of bare metal coronary stents and for a minimum of 1 year after placement of drug eluting stents. Because of the higher risk of bleeding, guidelines strongly recommend to delay elective surgery until dual antiplatelet therapy is ended. However, no data are available regarding the bleeding risk in patients on combined aspirin/clopidogrel therapy undergoing surgical or high-risk endoscopic procedures.
METHODS
We retrospectively analyzed the medical reports of patients on dual antiplatelet therapy, the patients who had to undergo emergency biliary-pancreatic surgery or endoscopic retrograde cholangiography with endoscopic sphincterotomy while in our unit between January 2009 and July 2012.
RESULTS
In our series, biliary-pancreatic surgical and endoscopic procedures were safely performed in 11 consecutive patients on dual antiplatelet therapy with no evidence of bleeding.
CONCLUSIONS
In emergency, surgical and high risk endoscopic procedures may be performed in patients on dual antiplatelet therapy.
摘要
背景/目的：裸金属冠状动脉支架置入后双联抗血小板治疗必须至少使用1个月，药物洗脱支架置入后至少使用1年。由于出血风险较高，指南强烈建议在双联抗血小板治疗结束前推迟择期手术。然而，关于接受联合阿司匹林/氯吡格雷治疗的患者在进行外科手术或高风险内镜检查时的出血风险，尚无相关数据。
方法
我们回顾性分析了2009年1月至2012年7月期间在我院接受双联抗血小板治疗、必须接受急诊胆胰手术或内镜逆行胰胆管造影术并进行内镜括约肌切开术的患者的病历报告。
结果
在我们的系列研究中，11例接受双联抗血小板治疗的患者安全地进行了胆胰外科手术和内镜检查，没有出血迹象。
结论
在紧急情况下，接受双联抗血小板治疗的患者可以进行外科手术和高风险内镜检查。
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本文引用的文献
1
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Ann Transplant. 2012 Apr-Jun;17(2):127-30. doi: 10.12659/aot.883231.
2
Major abdominal surgery with continued dual antiplatelet therapy.
Arch Surg. 2011 Nov;146(11):1334-5; author reply 1335-6. doi: 10.1001/archsurg.2011.300.
3
Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline.内镜检查与抗血小板药物。欧洲胃肠道内镜学会（ESGE）指南。
Endoscopy. 2011 May;43(5):445-61. doi: 10.1055/s-0030-1256317. Epub 2011 May 4.
4
The rate of post-polypectomy bleeding for patients on uninterrupted clopidogrel therapy during elective colonoscopy is acceptably low.在择期结肠镜检查期间，不停用氯吡格雷治疗的患者的息肉切除术后出血率可接受较低。
Dig Dis Sci. 2011 Sep;56(9):2631-8. doi: 10.1007/s10620-011-1682-2. Epub 2011 Apr 1.
5
Cessation of clopidogrel before major abdominal procedures.在进行重大腹部手术前停用氯吡格雷。
Arch Surg. 2011 Mar;146(3):334-9. doi: 10.1001/archsurg.2011.23.
6
ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use.ACCF/ACG/AHA 2010质子泵抑制剂与噻吩吡啶类药物联合使用专家共识文件：ACCF/ACG/AHA 2008关于降低抗血小板治疗和使用非甾体抗炎药胃肠道风险的专家共识文件重点更新版
Am J Gastroenterol. 2010 Dec;105(12):2533-49. doi: 10.1038/ajg.2010.445.
7
Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy.结肠镜检查中不停用氯吡格雷治疗患者的息肉切除术后出血。
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8
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9
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10
2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee.《美国心脏病学会/美国心脏协会经皮冠状动脉介入治疗指南2005年更新：2007年重点更新》：美国心脏病学会/美国心脏协会实践指南工作组报告：2007年写作组审查新证据并更新《美国心脏病学会/美国心脏协会经皮冠状动脉介入治疗指南2005年更新》，代表2005年写作委员会撰写
Circulation. 2008 Jan 15;117(2):261-95. doi: 10.1161/CIRCULATIONAHA.107.188208. Epub 2007 Dec 13.
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