Kadakia S C, Angueira C E, Ward J A, Moore M
Gastroenterology Service, Brooke Army Medical Center, San Antonio, Texas 78234-6200, USA.
Gastrointest Endosc. 1996 Sep;44(3):309-16. doi: 10.1016/s0016-5107(96)70170-0.
Gastrointestinal endoscopy is often required in patients taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or anticoagulants. Because proper guidelines are lacking, we believe that most endoscopists use their own criteria and judgment for stopping and restarting these agents during the periendoscopic period, and the practice varies widely. The aim of our study was to identify these practices among ASGE members.
Questionnaires, each containing 22 questions with 157 responses, were sent to 3300 ASGE members, including all Gastroenterology Fellowship Program Directors. One thousand two hundred sixty-nine questionnaires were received and analyzed.
Physicians stopped aspirin and NSAIDs more frequently before colonoscopy (81%) and ERCP (79%) than before upper endoscopy (51%) (p < 0.001). Ninety percent of physicians stopped aspirin and NSAIDs for 10 or fewer days. Only 20% of physicians performed sphincterotomy when aspirin and NSAIDs were not stopped compared with 88% and 85% (p < 0.001 for both) of physicians performing cold biopsies at esophagogastroduodenoscopy and colonoscopy, respectively, and 77% and 69% performing hot biopsies for the same procedures (p < 0.001 for all compared with sphincterotomy). Depending on the indication for anticoagulation, 51% to 60% of physicians stopped warfarin before upper endoscopy; 71% to 82% before colonoscopy; and 26% to 51% of physicians used a "heparin window." All physicians restarted warfarin immediately after diagnostic endoscopy, whereas 80% restarted it 7 or fewer days after therapeutic endoscopy.
We conclude that a wide variation exists regarding the management of aspirin, NSAIDs, and anticoagulants in the periendoscopic period. There is a definite need for a consensus statement or guidelines for managing patients taking these agents.
服用阿司匹林、非甾体抗炎药（NSAIDs）或抗凝剂的患者常常需要进行胃肠内镜检查。由于缺乏适当的指南，我们认为大多数内镜医师在围内镜检查期停用和重新启用这些药物时使用的是自己的标准和判断，且做法差异很大。我们研究的目的是确定美国胃肠内镜学会（ASGE）成员中的这些做法。
向3300名ASGE成员（包括所有胃肠病学 fellowship 项目主任）发送了问卷，每份问卷包含22个问题，共收到157份回复。共收到并分析了1269份问卷。
与上消化道内镜检查前（51%）相比，医师在结肠镜检查前（81%）和内镜逆行胰胆管造影（ERCP）前（79%）更频繁地停用阿司匹林和NSAIDs（p<0.001）。90%的医师停用阿司匹林和NSAIDs的时间为10天或更短。当未停用阿司匹林和NSAIDs时，只有20%的医师进行括约肌切开术，而在食管胃十二指肠镜检查和结肠镜检查时分别有88%和85%的医师进行冷活检（两者p<0.001），在相同检查中进行热活检的医师分别为77%和69%（与括约肌切开术相比，所有p<0.001）。根据抗凝指征，51%至60%的医师在上消化道内镜检查前停用华法林；结肠镜检查前为71%至82%；26%至51%的医师使用“肝素窗”。所有医师在诊断性内镜检查后立即重新启用华法林，而80%的医师在治疗性内镜检查后7天或更短时间内重新启用。
我们得出结论，围内镜检查期阿司匹林、NSAIDs和抗凝剂的管理存在很大差异。明确需要一份关于管理服用这些药物患者的共识声明或指南。
