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抗血小板药物会增加接受内镜黏膜下剥离术的胃部肿瘤患者的出血风险吗?

发布日期:2014-1-29 12:40:41 文章来源:GIE 作者次数:1099

    抗血小板药物会增加接受内镜黏膜下剥离术的胃部肿瘤患者的出血风险吗?

    背景

    使用抗血小板药是否会增加内镜黏膜下剥离术(ESD)后出血的风险,目前,对此很少人知道

    目的

    评估抗血小板药对内镜粘膜下剥离术后出血的影响。

    设计

    回顾性研究

    环境

    独立的,单一三级医疗转诊医疗咨询中心。

    患者病人

    1503例于20054月至20104月期间接受过ESD治疗的患者参与了本研究,共有1591处胃部肿瘤,包括815处腺瘤和776处早期胃癌。

    干预

    ESD内镜黏膜下剥离术。.

    主要测量指标测试结果

    明显呕血/便血,血红蛋白基线下降>2 g / dL,或内镜下止血,,血管造影栓塞术,和/或输血的要求。

    结果

    在这1591例受试者病例中,274例曾使用抗血小板药,其中102例在ESD治疗前中断使用7天以上。94例受试者在ESD术后发生出血事件,其中有20例来自连续用药组,6例来自于中断用药组,68例来自未服用抗血小板药物组。单因素分析显示,抗血小板药物,早期胃癌(EGC),合并症和样本直径和与ESD术治疗后出血相关。多因素分析显示,早期胃癌(优势比[OR]1.83995%置信区间[CI]1.168-2.896P = 0.009),合并症(OR2.24695CI1.280-3.939P = 0.005),样本直径(OR2.31595CI1.282-4.180P = 0.005)为ESD术后出血的独立风险因素,而尽管未没有使用血小板药物((OR1.59695% CI0.877-2.903P = 0.126)。在亚组分析发现,连续使用抗血小板药物不是在多因素分析中ESD术后出血的独立危险因素(OR2.027P=0.146)。在其中,102例中断使用抗血小板药物的受试者中,1例受试者发展为急性脑梗塞(1.0%)。

    局限性

    一项个回顾性的单中心分析、

    讨论

    对使用抗血小板药物的受试者来说,我们未发现连续给药与其内镜黏膜下剥离术后出血有显著独立相关性。

    缩写词EGC,早期胃癌;ESD,内镜黏膜下剥离术。

     


    Do antiplatelets increase the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms?

    Background

    It is rarely known whether antiplatelets increase the risk of bleeding after endoscopic submucosal dissection (ESD).

    Objective

    To evaluate the effect of antiplatelets on post-ESD bleeding.

    Design

    Retrospective study.

    Setting

    Single, tertiary-care referral center.

     

    Patients

    This study involved 1591 gastric neoplasms (815 adenomas and 776 early gastric cancers) in 1503 patients who had ESD between April 2005 and April 2010.

    Intervention

    ESD

    Main Outcome Measurements

    Overt hematemesis/hematochezia, a drop of hemoglobin >2 g/dL from baseline, or requirement of endoscopic hemostasis, angiographic embolization, and/or transfusion.

    Results

    Of 1591 subjects, 274 took antiplatelets, among whom 102 discontinued them for 7 days or more before ESD. Post-ESD bleeding occurred in 94 subjects including 20 from the continuation group, 6 from the withdrawal group, and 68 from the no-antiplatelet group. In univariate analysis, antiplatelets, early gastric cancer (EGC), comorbidity, and specimen diameter were related to post-ESD bleeding. In multivariate analysis, EGC (odds ratio [OR] 1.839; 95% confidence interval [CI], 1.168-2.896; P = .009), comorbidity (OR 2.246; 95% CI, 1.280-3.939; P = .005), and specimen diameter (OR 2.315; 95% CI, 1.282-4.180; P = .005) were independent risk factors of post-ESD bleeding, whereas antiplatelet usage was not (OR 1.596; 95% CI, 0.877-2.903; P = .126). In subgroup analysis, continuous antiplatelet usage was not found to be an independent risk factor of post-ESD bleeding in multivariate analysis (OR 2.027; P = .146). Among 102 subjects who discontinued antiplatelets, 1 developed an acute cerebral infarction (1.0%).

    Limitation

    A retrospective, single-center analysis.

     

    Conclusion

    In ESD for antiplatelet users, continuous administration was not found to have an independent significant association with bleeding.

    Abbreviations:  EGC, early gastric cancer, ESD, endoscopic submucosal dissection

     

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