Iwatsuka Kunio, Gotoda Takuji, Kusano Chika, Fukuzawa Masakatsu, Sugimoto Katsutoshi, Itoi Takao, Kawai Takashi, Moriyasu Fuminori
Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Gastric Cancer. 2014 Oct;17(4):680-5. doi: 10.1007/s10120-013-0333-z. Epub 2014 Jan 8.
The 2005 Japan Gastroenterological Endoscopy Society (JGES) guidelines for the management of antithrombotic drugs focused on the increasing risks of bleeding, even from biopsy during scheduled esophagogastroduodenoscopy (EGD). The new 2012 guidelines emphasized the prevention of thromboembolic complications. To compare with the new guidelines, we investigated the clinical management of EGD by clinicians under the former JGES guidelines for patients taking antithrombotic agents.
Medical records of 4574 patients (mean age 63.4 years, range 3-96 years, male/female ratio 2805/1769) who underwent scheduled EGD from April 2011 to March 2012 were reviewed retrospectively. The prescribed agents, pre-existing comorbidities, drug cessation before EGD, bleeding, and thromboembolic complications were investigated.
Five hundred forty-six patients (12.0 %) were taking antithrombotic drugs (aspirin, 313; warfarin, 134; cilostazol, 57; clopidogrel, 59; ethylicosapentate, 40; prostaglandin preparations, 41; ticlopidine, 29; icosapentate, 24; dipyridamole, 4); 116 and 29 patients, respectively, were managed with a combination of 2 or 3 agents. Among 490 patients whose medical records were precisely documented, 40.6 % underwent EGD without cessation. Bleeding and thromboembolic complications were not observed. The most common pre-existing comorbidity was ischemic heart disease (27.9 %), followed by carotid or intracranial large artery atherosclerosis (20.5 %), cerebral infarction or transient ischemic attack (20.3 %), and atrial fibrillation (15.9 %). Patients with pre-existing comorbidity requiring anticoagulants frequently underwent EGD without cessation.
We revealed the low impact of the 2005 JGES guidelines on the management of antithrombotic drugs. Our physicians have reasonably decided to continue antithrombotic drugs before EGD according to the risk of thromboembolism.
2005年日本胃肠内镜学会（JGES）发布的抗血栓药物管理指南关注了即使在常规食管胃十二指肠镜检查（EGD）活检时出血风险也在增加的情况。2012年的新指南则强调了预防血栓栓塞并发症。为了与新指南进行比较，我们调查了临床医生依据旧版JGES指南对服用抗血栓药物患者进行EGD检查的临床管理情况。
回顾性分析了2011年4月至2012年3月期间接受常规EGD检查的4574例患者（平均年龄63.4岁，年龄范围3 - 96岁，男女比例为2805/1769）的病历。调查了所开具的药物、既往合并症、EGD检查前停药情况、出血及血栓栓塞并发症。
546例患者（12.0%）正在服用抗血栓药物（阿司匹林313例；华法林134例；西洛他唑57例；氯吡格雷59例；二十碳五烯酸乙酯40例；前列腺素制剂41例；噻氯匹定29例；二十碳五烯酸24例；双嘧达莫4例）；分别有116例和29例患者联合使用了2种或3种药物。在490例病历记录准确的患者中，40.6%在未停药的情况下接受了EGD检查。未观察到出血和血栓栓塞并发症。最常见的既往合并症是缺血性心脏病（27.9%），其次是颈动脉或颅内大动脉粥样硬化（20.5%）、脑梗死或短暂性脑缺血发作（20.3%）以及心房颤动（15.9%）。需要抗凝治疗的既往合并症患者经常在未停药的情况下接受EGD检查。
我们发现2005年JGES指南对抗血栓药物管理的影响较小。我们的医生根据血栓栓塞风险合理地决定在EGD检查前继续使用抗血栓药物。
