Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Medicina (Kaunas). 2021 Feb 5;57(2):142. doi: 10.3390/medicina57020142.
The application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been markedly increased over the past decade. EBUS-TBNA is known to be a very safe and accurate procedure; however, the incidence of bleeding complications in patients who are taking antithrombotic agents (ATAs) is not well established. We conducted a retrospective analysis of a prospectively registered EBUS-TBNA cohort in a single tertiary hospital from May 2009 to December 2016. The patients were divided into two groups: an insufficient discontinuation group, defined as having a prescription for ATAs on the procedure day or only interrupting them for a short period of time, and a sufficient discontinuation group, defined as having prescription for ATAs during 30 days prior to the procedure and interrupting them for a sufficient period of time. During the study period, a total of 4271 patients, after excluding 3773 patients who did not take ATAs at all, 498 patients were classified into the insufficient discontinuation group ( = 102) and the sufficient discontinuation group ( = 396). The baseline characteristics of patients and examined lesions between two groups were not significantly different, except insufficient discontinuation group had longer prothrombin times than the sufficient discontinuation group. In the insufficient discontinuation group, the most common reasons for prescriptions of ATAs were ischemic heart disease (48.0%) and cerebral vascular disease (28.4%), and half of the patients were taking two or more ATAs. Eventually, only one bleeding complication in the insufficient discontinuation group (1/102, 1.0%) and one event in the sufficient discontinuation group (1/396, 0.3%) occurred ( = 0.368). EBUS-TBNA is considered a safe procedure in terms of bleeding complications, even in patients with insufficient stopping of ATAs.
在过去的十年中，支气管内超声引导经支气管针吸活检术（EBUS-TBNA）的应用显著增加。EBUS-TBNA 被认为是一种非常安全和准确的程序；然而，服用抗血栓药物（ATAs）的患者发生出血并发症的发生率尚不清楚。我们对 2009 年 5 月至 2016 年 12 月期间在一家三级医院进行的前瞻性登记的 EBUS-TBNA 队列进行了回顾性分析。患者分为两组：停药不足组，定义为在手术当天有 ATA 处方或仅短时间停药；停药充分组，定义为在手术前 30 天内有 ATA 处方并停药足够时间。在研究期间，共 4271 例患者，排除根本不服用 ATA 的 3773 例患者后，498 例患者分为停药不足组（n=102）和停药充分组（n=396）。两组患者的基线特征和检查病变无显著差异，除停药不足组的凝血酶原时间较停药充分组长。在停药不足组中，ATA 处方最常见的原因是缺血性心脏病（48.0%）和脑血管疾病（28.4%），一半的患者服用两种或更多种 ATA。最终，停药不足组仅发生 1 例出血并发症（1/102，1.0%），停药充分组发生 1 例事件（1/396，0.3%）（ = 0.368）。从出血并发症的角度来看，EBUS-TBNA 被认为是一种安全的程序，即使在停药不足的患者中也是如此。
