Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Vasc Interv Radiol. 2021 Jun;32(6):869-877. doi: 10.1016/j.jvir.2021.02.021. Epub 2021 Mar 6.
To evaluate the safety of radiofrequency ablation (RFA) for liver tumors in patients on antithrombotic therapy.
A total of 10,653 consecutive RFA treatments in 3,485 patients with liver tumors were analyzed. The incidence of complications was analyzed on a treatment basis. The treatments for patients who had received antithrombotic medication up to 1 week prior to RFA comprised the antithrombotic therapy group (n = 806), and the others comprised the control group (n = 9,847). Antithrombotic agents were ceased prior to RFA (aspirin, ticlopidine, clopidogrel, and prasugrel ceased 7 days before RFA; cilostazol, 2 or 3 days before RFA; warfarin, 3 days before RFA; and direct oral anticoagulants, 1 day before RFA) and resumed as soon as possible after RFA. Logistic regression analysis was performed to assess whether the antithrombotic therapy increased the risk of hemorrhagic complications.
Hemorrhagic complications were diagnosed after 6 treatments (0.7%) in the antithrombotic group and 48 (0.5%) in the control group, and there was no significant difference between the groups (P = .30). In 3 treatments, hemorrhage was diagnosed on or after 8 days of RFA, all of which were in the antithrombotic group. Thrombotic complications were diagnosed after 2 treatments (0.2%) in the antithrombotic group and after 5 (0.1%) in the control group. In a multivariate analysis, receiving antithrombotic therapy was not an independent risk factor for hemorrhagic complications (adjusted odds ratio, 1.52; 95% confidence interval, 0.60-3.87; P = .38).
RFA of liver tumors in patients on antithrombotic therapy is generally safe with appropriate cessation and resumption. Late-onset hemorrhage should be noted in the patients on antithrombotic therapy.
评估抗血栓治疗患者行射频消融术（RFA）治疗肝脏肿瘤的安全性。
共分析了 3485 例肝脏肿瘤患者的 10653 例连续 RFA 治疗。基于治疗对并发症发生率进行了分析。在 RFA 前 1 周内接受抗血栓治疗的患者的治疗纳入抗血栓治疗组（n=806），其余患者纳入对照组（n=9847）。RFA 前停止抗血栓药物（阿司匹林、噻氯匹定、氯吡格雷和普拉格雷在 RFA 前 7 天停止；西洛他唑在 RFA 前 2 或 3 天停止；华法林在 RFA 前 3 天停止；直接口服抗凝剂在 RFA 前 1 天停止），并在 RFA 后尽快恢复。采用 logistic 回归分析评估抗血栓治疗是否增加出血性并发症的风险。
抗血栓组有 6 例（0.7%）治疗后出现出血性并发症，对照组有 48 例（0.5%），两组间无显著差异（P=0.30）。其中 3 例在 RFA 后 8 天或之后确诊出血，均在抗血栓组。抗血栓组有 2 例（0.2%）治疗后出现血栓性并发症，对照组有 5 例（0.1%）。多变量分析显示，接受抗血栓治疗不是出血性并发症的独立危险因素（调整后的优势比，1.52；95%置信区间，0.60-3.87；P=0.38）。
对于接受抗血栓治疗的患者，行肝脏肿瘤 RFA 一般是安全的，只要适当停止和恢复抗血栓治疗。对于接受抗血栓治疗的患者，应注意迟发性出血。
