Karna Rahul, Hans Bandhul, Nasereddin Thayer, Chaudhary Dhruv, Dhawan Manish
Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA.
Proc (Bayl Univ Med Cent). 2024 Jul 29;37(5):734-741. doi: 10.1080/08998280.2024.2381180. eCollection 2024.
Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a complication of dual antiplatelet therapy (DAPT) and direct oral anticoagulant therapy (DOAC). There is a lack of data comparing mechanical therapy (clips) with thermal therapy in this population.
We conducted a retrospective chart review of patients undergoing urgent/emergent endoscopy for NVUGIB while being on DAPT or DOAC. Patients who had DAPT/DOAC held as per American Society of Gastrointestinal Endoscopy guidelines were excluded from the study.
A total of 122 patients were included in the study. There was no difference in primary hemostasis, rebleeding rate, rescue hemostatic procedure, and 30-day mortality between the mechanical and thermal therapy groups. The mechanical therapy group had a significantly higher rate of prolonged length of stay (61.2% vs 38.9%, = 0.02), serious clinical outcomes (56% vs 37.5%, = 0.04), and intensive care unit admissions (50% vs 20.8%, = 0.001) than the thermal therapy group.
Patients on DAPT/DOAC presenting with NVUGIB can undergo mechanical or thermal endoscopic intervention without a significant difference in achieving primary hemostasis, rebleeding, requiring a secondary procedure, or mortality outcomes.
非静脉曲张性上消化道出血（NVUGIB）是双联抗血小板治疗（DAPT）和直接口服抗凝治疗（DOAC）的一种并发症。在这一人群中，缺乏比较机械治疗（夹子）和热治疗的数据。
我们对接受DAPT或DOAC治疗的NVUGIB患者进行紧急/急诊内镜检查的病历进行了回顾性分析。根据美国胃肠内镜学会指南停用DAPT/DOAC的患者被排除在研究之外。
共有122例患者纳入研究。机械治疗组和热治疗组在首次止血、再出血率、挽救性止血程序和30天死亡率方面无差异。与热治疗组相比，机械治疗组住院时间延长率（61.2%对38.9%，P = 0.02）、严重临床结局发生率（56%对37.5%，P = 0.04）和重症监护病房入住率（50%对20.8%，P = 0.001）显著更高。
出现NVUGIB的DAPT/DOAC患者可接受机械或热内镜干预，在实现首次止血、再出血、需要二次手术或死亡率结局方面无显著差异。
