抗血栓药物致结直肠息肉切除术后出血的风险分析。

Risk Analysis of Colorectal Post-Polypectomy Bleeding Due to Antithrombotic Agent.

机构信息

Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.

Division of Endoscopy, Shizuoka Cancer Center, Shizuoka,

出版信息

Digestion. 2019;99(2):148-156. doi: 10.1159/000490791. Epub 2018 Sep 4.

DOI:10.1159/000490791

PMID:30179871

Abstract

BACKGROUND/AIMS: Post-polypectomy bleeding (PPB) is a major complication of colorectal polypectomy, and antithrombotics is one of the major risk factors of PPB. The purpose of this study was to investigate PPB risks with regard to the combinations of antithrombotic agents used.

METHODS

We retrospectively reviewed cases involving colonoscopic polyp resection between September 2002 and December 2014. The risk of PPB was assessed according to patient and lesion factors, including antithrombotic use. Antithrombotics were discontinued before polypectomy.

RESULTS

A total of 6,382 colonoscopies with 12,876 polypectomies were analyzed. PPB occurred in 55 patients (0.9%) and 63 lesions (0.5%). Among patients treated with antithrombotics, heparin bridging (HB) therapy was an independent risk factor of PPB (per patient, 20%, OR 33.1, p < 0.001; per lesion, 9.1%, OR 17.3, p < 0.001) compared to those without antithrombotics (per patient 0.7%; per lesion 0.4%). Among patients without HB, the combination of anticoagulant + antiplatelet agents was significantly associated with PPB (per patient, 5%, OR 7.73, p = 0.007; per lesion, 2.4%, OR 6.31, p = 0.003).

CONCLUSION

HB therapy is a major risk factor for PPB. Among patients without HB, anticoagulant + antiplatelet therapy was a significant risk factor for PPB.

摘要

背景/目的：肠息肉切除术后出血（PPB）是结直肠息肉切除术后的主要并发症之一，抗血栓药物是 PPB 的主要危险因素之一。本研究旨在探讨抗血栓药物联合使用与 PPB 风险的关系。

方法

我们回顾性分析了 2002 年 9 月至 2014 年 12 月间行结肠镜下息肉切除术的病例。根据患者和病变因素评估 PPB 的风险，包括抗血栓药物的使用。抗血栓药物在息肉切除术前停用。

结果

共分析了 6382 例结肠镜检查和 12876 例息肉切除术。55 例（0.9%）和 63 处病变（0.5%）发生了 PPB。在使用抗血栓药物的患者中，肝素桥接（HB）治疗是 PPB 的独立危险因素（每例患者 20%，OR 33.1，p < 0.001；每处病变 9.1%，OR 17.3，p < 0.001），与未使用抗血栓药物的患者相比（每例患者 0.7%；每处病变 0.4%）。在未行 HB 治疗的患者中，抗凝+抗血小板药物联合使用与 PPB 显著相关（每例患者 5%，OR 7.73，p = 0.007；每处病变 2.4%，OR 6.31，p = 0.003）。