Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan.
Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Can J Gastroenterol Hepatol. 2021 May 21;2021:6672440. doi: 10.1155/2021/6672440. eCollection 2021.
The present study aimed to clarify the safety and efficacy of the noncessation method of antithrombotic agents after emergency endoscopic hemostasis in patients with nonvariceal upper gastrointestinal bleeding (UGIB).
In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for nonvariceal UGIB in patients taking antithrombotic agents and resumed the medications without a cessation period (group A). The clinical characteristics, types of antithrombotic agents, UGIB etiology, treatment outcome, and adverse events were evaluated. We used propensity score matching to compare treatment outcomes and adverse events with our previous cohort (group B) in whom antithrombotic agents were transiently discontinued after emergency endoscopic hemostasis.
Forty-three consecutive patients were prospectively enrolled. The main antithrombotic agents were low-dose aspirin and direct oral anticoagulants; 11 patients (25.6%) were taking multiple antithrombotics. Peptic ulcers were the main cause of bleeding (95.4%). Endoscopic hemostasis was successful in all patients and the incidence of rebleeding within a month was 7.0%. Propensity score matching created 40 matched pairs. Endoscopic hemostasis was performed by soft coagulation significantly more frequently in group A than in group B (97.5% versus 60.0%, < 0.001). Neither the rebleeding rate within a month nor thromboembolic event rate was different between the two groups. However, the mean duration of hospitalization was significantly shorter in group A than in group B (8.6 ± 5.2 d versus 14.4 ± 7.1 d, < 0.001).
Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for nonvariceal UGIB.
本研究旨在明确非静脉曲张性上消化道出血（UGIB）患者接受紧急内镜止血后不停用抗血栓药物的安全性和疗效。
在这项多中心前瞻性初步研究中，我们对正在服用抗血栓药物的非静脉曲张性 UGIB 患者进行紧急内镜止血，并在不停药的情况下恢复药物治疗（A 组）。评估了临床特征、抗血栓药物类型、UGIB 病因、治疗结果和不良事件。我们使用倾向评分匹配，将治疗结果和不良事件与我们之前接受紧急内镜止血后短暂停用抗血栓药物的队列（B 组）进行比较。
连续纳入了 43 例患者。主要抗血栓药物为低剂量阿司匹林和直接口服抗凝剂；11 例（25.6%）患者同时服用多种抗血栓药物。消化性溃疡是出血的主要病因（95.4%）。所有患者均成功进行了内镜止血，1 个月内再出血率为 7.0%。通过倾向评分匹配，创建了 40 对匹配对。A 组内镜止血时软凝法的使用率显著高于 B 组（97.5%比 60.0%， < 0.001）。两组 1 个月内再出血率和血栓栓塞事件率无差异。但 A 组的平均住院时间明显短于 B 组（8.6 ± 5.2 d 比 14.4 ± 7.1 d， < 0.001）。
非静脉曲张性 UGIB 患者接受紧急内镜止血后，抗血栓药物可能可以继续使用。
