Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Hanmaeum Hospital, Jeju-si, Korea.
Dig Endosc. 2014 Nov;26(6):737-44. doi: 10.1111/den.12271. Epub 2014 Mar 27.
The effect of platelet aggregation inhibitors (PAI) on post-endoscopic sphincterotomy (ES) bleeding in patients who cannot discontinue PAI for sufficient time in urgent conditions has not been identified. The present study analyzed the effect of sustained use of PAI on post-procedural bleeding in patients undergoing ES.
A total of 762 patients were grouped into one of the following groups: no-PAI group (n = 601), continuation group (n = 132), and withdrawal group (n = 29). The continuation group included sustained PAI therapy (sustained user, n = 49) or those in whom therapy was interrupted <7 days prior to ES (non-sustained user, n = 83). The primary outcome was defined as the incidence, type, and severity of post-ES bleeding among groups.
There were no significant differences between incidence, type, or severity of post-ES bleeding in the three groups. Among 132 patients with continued use of PAI, there was no significant difference regarding incidence and severity of bleeding according to sustained or non-sustained use (P = 0.071 and P = 0.086, respectively). However, post-ES delayed bleeding was more frequent in sustained PAI users than in non-sustained users (7/49, 14.3% vs 2/83, 2.4%) and was significantly associated with sustained PAI therapy in the continuation group (P = 0.013).
Sustained use of PAI without interruption until ES might increase the risk of delayed bleeding.
在紧急情况下，血小板聚集抑制剂 (PAI) 不能停药足够时间的患者，其内镜下括约肌切开术 (ES) 后出血的影响尚未确定。本研究分析了持续使用 PAI 对 ES 后患者术后出血的影响。
将 762 例患者分为以下几组：无 PAI 组（n = 601）、持续组（n = 132）和停药组（n = 29）。持续组包括持续 PAI 治疗（持续使用者，n = 49）或 ES 前 7 天内中断治疗的患者（非持续使用者，n = 83）。主要结局定义为各组 ES 后出血的发生率、类型和严重程度。
三组之间 ES 后出血的发生率、类型或严重程度无显著差异。在持续使用 PAI 的 132 例患者中，根据持续或非持续使用，出血的发生率和严重程度无显著差异（P = 0.071 和 P = 0.086）。然而，持续 PAI 使用者 ES 后迟发性出血的发生率高于非持续使用者（7/49，14.3%比 2/83，2.4%），且与持续组中的持续 PAI 治疗显著相关（P = 0.013）。
在 ES 之前不停药持续使用 PAI 可能会增加迟发性出血的风险。
