Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan.
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.
Dig Dis Sci. 2019 Nov;64(11):3247-3255. doi: 10.1007/s10620-019-5469-1. Epub 2019 Jan 25.
With the aging of the population and rising incidence of thromboembolic events, the clinical use of antithrombotic agents is also increasing. There are few reports yet on the management of antithrombotic agent use in patients undergoing cold snare polypectomy (CSP).
The aim of this study was to evaluate whether continued administration of antithrombotic agents in patients undergoing CSP would be associated with an increased rate of delayed post-polypectomy bleeding (DPPB).
A total of 1177 colorectal polyps in 501 patients were resected at Omori Red Cross Hospital between October 2017 and March 2018. The polyps were divided into two groups depending on whether the patients received antithrombotic agent treatment or not: the antithrombotic group (911 polyps) and the no-antithrombotic group (266 polyps).
Among the 1177 polyp resections, there was no case of DPPB, including in the antithrombotic group. Immediate bleeding occurred in a total of 63 (5.4%) cases. Polyp location in the rectum (OR (95% CI) 2.64 (1.223-5.679); p = 0.013), polyp size ≥ 6 mm (OR (95% CI) 4.64 (2.719-7.933); p < 0.001), polypoid growth pattern (OR (95% CI) 2.78 (1.607-4.793); p < 0.001), and antithrombotic agent use (OR (95% CI) 2.98 (1.715-5.183); p < 0.001) were identified as significant risk factors of immediate bleeding.
Continued use of antithrombotic agents does not increase the risk of DPPB, even in those receiving multiple antithrombotic agents. Thus, it is safe to perform CSP even in multiple agent users. Prospective, randomized studies are necessary to confirm our results.
随着人口老龄化和血栓栓塞事件发生率的上升，抗血栓药物的临床应用也在增加。然而，目前关于冷圈套息肉切除术（CSP）患者抗血栓药物使用管理的报道较少。
本研究旨在评估 CSP 患者继续使用抗血栓药物是否会增加延迟性息肉切除后出血（DPPB）的发生率。
2017 年 10 月至 2018 年 3 月，在大森红十字医院对 501 例患者的 1177 个结直肠息肉进行了切除。根据患者是否接受抗血栓药物治疗，将息肉分为两组：抗血栓组（911 个息肉）和非抗血栓组（266 个息肉）。
在 1177 例息肉切除中，包括抗血栓组在内，均无 DPPB 发生。总共有 63 例（5.4%）发生即刻出血。直肠息肉位置（OR（95%CI）2.64（1.223-5.679）；p=0.013）、息肉大小≥6mm（OR（95%CI）4.64（2.719-7.933）；p<0.001）、息肉形态呈息肉样（OR（95%CI）2.78（1.607-4.793）；p<0.001）和抗血栓药物使用（OR（95%CI）2.98（1.715-5.183）；p<0.001）被确定为即刻出血的显著危险因素。
继续使用抗血栓药物并不会增加 DPPB 的风险，即使患者同时使用多种抗血栓药物也是如此。因此，即使是多药使用者，行 CSP 也是安全的。需要前瞻性、随机研究来证实我们的结果。
