接受口服抗凝剂治疗的患者在治疗性胃肠内镜检查后延迟出血的危险因素：一项多中心回顾性研究。

Risk Factors for Delayed Bleeding after Therapeutic Gastrointestinal Endoscopy in Patients Receiving Oral Anticoagulants: A Multicenter Retrospective Study.

作者信息

Kubo Kimitoshi, Kato Mototsugu, Mabe Katsuhiro, Harada Naohiko, Iboshi Yoichiro, Kagaya Takashi, Ono Masayoshi, Toyokawa Tatsuya, Yamashita Haruhiro, Kuwai Toshio, Hamada Hiroshige, Sakakibara Yuko, Nishiyama Hitoshi, Ara Nobuyuki, Mori Hideki, Matsumoto Mio, Takahashi Yasuo, Katsushima Shinji, Watanabe Noriko, Ogura Yoshito, Saito Hiroki, Masuda Eiji, Amano Toraji

机构信息

Departments of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan,

Departments of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan.

出版信息

Digestion. 2021;102(2):161-169. doi: 10.1159/000502952. Epub 2019 Sep 10.

DOI:10.1159/000502952

PMID:31505493

Abstract

BACKGROUND/AIMS: Delayed bleeding is among the adverse events associated with therapeutic gastrointestinal endoscopy. The aim of this study was to evaluate risk factors for delayed bleeding after gastrointestinal endoscopic resection in patients receiving oral anticoagulants as well as to compare the rates of occurrence of delayed bleeding between the oral anticoagulants used.

METHODS

We retrospectively analyzed a total of 772 patients receiving anticoagulants. Of these, 389 and 383 patients were receiving direct oral anticoagulants (DOACs) and warfarin, respectively. Therapeutic endoscopic procedures performed included endoscopic submucosal dissection (ESD), endoscopic mucosal resection, polypectomy, and cold polypectomy.

RESULTS

Delayed bleeding occurred in 90 patients (11.7%) with no significant difference between the DOAC and warfarin groups (9.5 and 13.8%, respectively). Delayed bleeding occurred significantly more frequently with apixaban than with rivaroxaban (13.5 vs. 6.4%; p < 0.05). A multivariate analysis identified continued anticoagulant therapy (OR 2.29), anticoagulant withdrawal with heparin bridging therapy (HBT; OR 2.18), anticoagulant therapy combined with 1 antiplatelet drug (OR 1.72), and ESD (OR 3.87) as risk factors for delayed bleeding.

CONCLUSION

This study identified continued anticoagulant therapy, anticoagulant withdrawal with HBT, anticoagulant therapy combined with 1 antiplatelet drug, and ESD as risk factors for delayed bleeding after therapeutic endoscopy in patients receiving oral anticoagulants. Delayed bleeding rates were not significantly different between those receiving DOACs and warfarin. It was also suggested that the occurrence of delayed bleeding may vary between different DOACs and that oral anticoagulant withdrawal should be minimized during therapeutic gastrointestinal endoscopy, given the thromboembolic risk involved.

摘要

背景/目的：迟发性出血是治疗性胃肠内镜检查相关的不良事件之一。本研究的目的是评估接受口服抗凝剂治疗的患者在胃肠内镜切除术后迟发性出血的危险因素，并比较所用口服抗凝剂之间迟发性出血的发生率。

方法

我们回顾性分析了总共772例接受抗凝剂治疗的患者。其中，分别有389例和383例患者接受直接口服抗凝剂（DOACs）和华法林治疗。所进行的治疗性内镜手术包括内镜黏膜下剥离术（ESD）、内镜黏膜切除术、息肉切除术和冷息肉切除术。

结果

90例患者（11.7%）发生迟发性出血，DOAC组和华法林组之间无显著差异（分别为9.5%和13.8%）。阿哌沙班组迟发性出血的发生率显著高于利伐沙班组（13.5%对6.4%；p<0.05）。多因素分析确定继续抗凝治疗（比值比2.29）、采用肝素桥接治疗（HBT）停用抗凝剂（比值比2.18）、抗凝治疗联合1种抗血小板药物（比值比1.72）和ESD（比值比3.87）为迟发性出血的危险因素。

结论

本研究确定继续抗凝治疗、采用HBT停用抗凝剂、抗凝治疗联合1种抗血小板药物和ESD是接受口服抗凝剂治疗的患者在治疗性内镜检查后迟发性出血的危险因素。接受DOACs和华法林治疗的患者之间迟发性出血率无显著差异。还提示不同DOACs之间迟发性出血的发生率可能有所不同，并且鉴于涉及的血栓栓塞风险，在治疗性胃肠内镜检查期间应尽量减少口服抗凝剂的停用。