Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
Ohta Nishinouchi Hospital, Fukushima 963-8022, Japan.
World J Gastroenterol. 2018 Apr 14;24(14):1540-1549. doi: 10.3748/wjg.v24.i14.1540.
To verify the validity of the endoscopy guidelines for patients taking warfarin or direct oral anticoagulants (DOAC).
We collected data from 218 patients receiving oral anticoagulants (73 DOAC users, 145 warfarin users) and 218 patients not receiving any antithrombotics (age- and sex-matched controls) who underwent polypectomy. (1) We evaluated post-polypectomy bleeding (PPB) risk in patients receiving warfarin or DOAC compared with controls; (2) we assessed the risks of PPB and thromboembolism between three AC management methods: Discontinuing AC with heparin bridge (HPB) (endoscopy guideline recommendation), continuing AC, and discontinuing AC without HPB.
PPB rate was significantly higher in warfarin users and DOAC users compared with controls (13.7% and 13.7% 0.9%, < 0.001), but was not significantly different between rivaroxaban (13.2%), dabigatran (11.1%), and apixaban (13.3%) users. Two thromboembolic events occurred in warfarin users, but none in DOAC users. Compared with the continuing anticoagulant group, the discontinuing anticoagulant with HPB group (guideline recommendation) had a higher PPB rate (10.8% 19.6%, = 0.087). These findings were significantly evident in warfarin but not DOAC users. One thrombotic event occurred in the discontinuing anticoagulant with HPB group and the discontinuing anticoagulant without HPB group; none occurred in the continuing anticoagulant group.
PPB risk was similar between patients taking warfarin and DOAC. Thromboembolism was observed in warfarin users only. The guideline recommendations for HPB should be re-considered.
验证针对服用华法林或直接口服抗凝剂（DOAC）患者的内镜指南的有效性。
我们收集了 218 例接受口服抗凝剂（73 例 DOAC 使用者，145 例华法林使用者）和 218 例未接受任何抗血栓药物治疗的患者（年龄和性别匹配的对照组）的息肉切除术数据。（1）我们评估了与对照组相比，服用华法林或 DOAC 的患者的息肉切除术后出血（PPB）风险；（2）我们评估了三种抗凝血管理方法（继续抗凝、停用抗凝但无肝素桥接、停用抗凝并使用肝素桥接）之间的 PPB 和血栓栓塞风险。
与对照组相比，华法林使用者和 DOAC 使用者的 PPB 发生率明显更高（13.7%和 13.7%， 0.9%， <0.001），但利伐沙班（13.2%）、达比加群（11.1%）和阿哌沙班（13.3%）使用者之间无显著差异。华法林使用者发生 2 例血栓栓塞事件，DOAC 使用者未发生血栓栓塞事件。与继续抗凝组相比，停用抗凝并使用肝素桥接组（指南推荐）的 PPB 发生率更高（10.8% 19.6%， = 0.087）。这些发现对华法林使用者明显，但在 DOAC 使用者中不明显。肝素桥接组和肝素桥接组均发生 1 例血栓栓塞事件，继续抗凝组未发生血栓栓塞事件。
服用华法林和 DOAC 的患者的 PPB 风险相似。仅在华法林使用者中观察到血栓栓塞。肝素桥接的指南推荐应重新考虑。
