Fischbach Wolfgang
Innere Medizin und Gastroenterologie Aschaffenburg, Aschaffenburg, Germany.
Visc Med. 2020 Aug;36(4):274-279. doi: 10.1159/000508580. Epub 2020 Aug 4.
Platelet inhibition and anticoagulation are widely used therapeutic approaches in many patients. Despite their undoubted cardiovascular benefits, they may cause gastrointestinal harm either spontaneously or as part of endoscopic procedures. Strategies which harmonize both aspects are, therefore, of clinical interest.
The websites of the German (DGVS), European (ESGE), and American (ASGE) Societies of Gastroenterology and Endoscopy were searched for guidelines on antithrombotic agents and endoscopic procedures. Over and beyond this, PubMed was analyzed for originals and reviews by using the keywords "hemostasis affecting drugs," "antithrombotic drugs," "platelet inhibition," "anticoagulation," AND endoscopy.
If elective endoscopy is planned, we should consider postponing the procedure in cases of temporally restricted platelet inhibition therapy or anticoagulation. Urgent endoscopy must balance the procedural risk against the risk of continuing or stopping the medication, with respect to thromboembolic events on the one hand and gastrointestinal bleeding on the other. There are decision criteria which facilitate individual risk stratification as a basis for diagnostic and therapeutic algorithms.
If endoscopic interventions under platelet inhibition and/or anticoagulation cannot be postponed for a limited period of time, diagnostic and therapeutic strategies have to be performed against the background of well-defined decision criteria. These include the procedural risk (low vs. high) and the risk of thromboembolic events occurring (low vs. high) if the medication is stopped. In cases where both risks are considered to be high, an interdisciplinary approach should be favored.
血小板抑制和抗凝是许多患者广泛使用的治疗方法。尽管它们具有毋庸置疑的心血管益处，但它们可能会自发地或作为内镜检查程序的一部分导致胃肠道损伤。因此，兼顾这两个方面的策略具有临床意义。
检索德国胃肠病学和内镜学会（DGVS）、欧洲胃肠病学和内镜学会（ESGE）以及美国胃肠病学和内镜学会（ASGE）的网站，查找关于抗血栓药物和内镜检查程序的指南。除此之外，通过使用关键词“影响止血的药物”、“抗血栓药物”、“血小板抑制”、“抗凝”和“内镜检查”，对PubMed进行了原文和综述分析。
如果计划进行择期内镜检查，对于有时间限制的血小板抑制治疗或抗凝治疗的情况，我们应考虑推迟该检查。紧急内镜检查必须在手术风险与继续或停止用药的风险之间进行权衡，一方面要考虑血栓栓塞事件，另一方面要考虑胃肠道出血。有一些决策标准有助于进行个体风险分层，作为诊断和治疗算法的基础。
如果在血小板抑制和/或抗凝情况下的内镜干预不能在有限时间内推迟，必须在明确的决策标准背景下实施诊断和治疗策略。这些标准包括手术风险（低与高）以及如果停药发生血栓栓塞事件的风险（低与高）。在两种风险都被认为很高的情况下，应优先采用跨学科方法。
