Division of Gastroenterology, Department of Medicine, University of British Columbia, 770-1190 Hornby Street, Vancouver, British Columbia V6Z2K5, Canada.
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
Gastrointest Endosc Clin N Am. 2022 Apr;32(2):299-312. doi: 10.1016/j.giec.2021.12.006.
Antithrombotic medications, including antiplatelet drugs and anticoagulants, are widely prescribed to prevent thromboembolic disease. There is limited evidence informing gastroenterologists of the management of patients on antithrombotic medications undergoing colonoscopy and polypectomy. A patient's risk of thromboembolism versus postpolypectomy bleeding should be carefully considered, incorporating patient preferences concerning benefits and harms of temporary antithrombotic interruption. We will review the available consensus guidelines, current literature, and strategies to mitigate the risk of bleeding following polypectomy. These will be interpreted in the framework of shared decision-making with the patient to arrive at the safest solution best aligned with the patient's preferences.
抗血栓药物,包括抗血小板药物和抗凝剂,被广泛用于预防血栓栓塞性疾病。然而,对于正在接受结肠镜检查和息肉切除术的抗血栓药物治疗的患者,胃肠病学家在管理方面的相关证据有限。在权衡血栓栓塞风险与息肉切除术后出血风险时,应仔细考虑患者的偏好,包括对临时抗血栓药物中断的利弊的看法。我们将回顾现有的共识指南、当前文献以及降低息肉切除术后出血风险的策略。这些策略将在与患者共同决策的框架内进行解释,以找到与患者偏好最一致的最安全解决方案。