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首页> 外文期刊>Digestion >Effects of Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment on Postoperative Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matching Analysis
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Effects of Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment on Postoperative Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matching Analysis

机译：胃肠学内镜治疗术后早期患者患者胃肠内腔治疗术后早期胃癌术后患者的影响：倾向分数分析

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摘要

Background: Management of antithrombotic agents during endoscopic treatment changed after the publishing of -Japan Gastroenterological Endoscopy Society guidelines for gastroenterological endoscopy in antithrombotic drug users (GL-2012). Objectives: We aimed to evaluate the effect of implementing antithrombotic agent management guidelines (GL-2012) on postoperative bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and on the prevention of thromboembolic events. Methods: A total of 1,264 patients who underwent ESD for EGC at Kyoto Prefectural University Hospital between June 2002 and March 2017 were enrolled and divided into 2 groups: 621 patients before the publication of GL-2012 (Pre-GL group) and 643 patients after (Post-GL group). Relationships between postoperative bleeding and various clinicopathological factors in each group were investigated through propensity score-matching analysis. Results: In the Pre-GL group, antihypertensive agent use (p < 0.01) and upper third of the stomach (p < 0.01) were significantly related to postoperative bleeding in univariate analysis. Antihypertensive agent use (OR 4.6, 95% CI 1.6-12.8) and upper third of the stomach (OR 4.9, 95% CI 1.8-13.4) were significantly related to postoperative bleeding in multivariate analysis. In the Post-GL group, antihypertensive agent use (p < 0.01), dual antiplatelet agents use (p < 0.01), anticoagulant agents use (p < 0.01), and heparin replacement therapy (p < 0.01) were significantly related to postoperative bleeding in univariate analysis. Antihypertensive agent use (OR 3.4, 95% CI 1.1-9.6), dual antiplatelet agents (OR 12.3, 95% CI 2.4-63.0), and heparin replacement therapy (OR 10.2, 95% CI 2.5-41.5) were significantly related to postoperative bleeding in multivariate analysis. Conclusions: The adherence to GL-2012 might reduce risk of thromboembolic events. On the other hand, dual antiplatelet agents therapy and heparin replacement therapy were the new independent risk factors for ESD postoperative bleeding in EGC after GL-2012. Especially as for heparin replacement therapy, uninterrupted warfarin or a temporary short interruption of direct oral anticoagulants without heparin replacement therapy might be recommended rather than heparin replacement therapy.
机译：背景：日本胃肠内镜学会《抗血栓药物使用者胃肠内镜检查指南》（GL-2012）出版后，内镜治疗期间抗血栓药物的管理发生了变化。目的：我们旨在评估实施抗血栓药物管理指南（GL-2012）对早期胃癌（EGC）内镜黏膜下剥离术（ESD）术后出血和预防血栓栓塞事件的影响。方法：2002年6月至2017年3月，共有1264名患者在京都县大学医院接受了EGC ESD治疗，并将其分为两组：GL-2012发布前的621名患者（GL前组）和GL发布后的643名患者（GL后组）。通过倾向评分匹配分析，研究各组术后出血与各种临床病理因素之间的关系。结果：单因素分析显示，在GL前组中，抗高血压药物的使用（p<0.01）和胃上部三分之一（p<0.01）与术后出血显著相关。在多变量分析中，抗高血压药物的使用（OR 4.6，95%可信区间1.6-12.8）和胃上部三分之一（OR 4.9，95%可信区间1.8-13.4）与术后出血显著相关。单因素分析显示，在GL后组中，抗高血压药物的使用（p<0.01）、双重抗血小板药物的使用（p<0.01）、抗凝剂的使用（p<0.01）和肝素替代治疗（p<0.01）与术后出血显著相关。在多变量分析中，抗高血压药物的使用（OR 3.4，95%可信区间1.1-9.6）、双重抗血小板药物（OR 12.3，95%可信区间2.4-63.0）和肝素替代治疗（OR 10.2，95%可信区间2.5-41.5）与术后出血显著相关。结论：遵守GL-2012可能会降低血栓栓塞事件的风险。另一方面，双重抗血小板药物治疗和肝素替代治疗是GL-2012后EGC术后ESD出血的新独立危险因素。尤其是对于肝素替代治疗，建议不间断华法林或暂时中断直接口服抗凝剂而不进行肝素替代治疗，而不是肝素替代治疗。

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  • 来源
    《Digestion》 |2021年第2期|共9页
  • 作者

    Terasaki Kei; Dohi Osamu; Naito Yuji; Azuma Yuka; Ishida Tsugitaka; Kitae Hiroaki; Matsumura Shinya; Ogita Kazuyuki; Takayama Shun; Mizuno Naoki; Nakano Takahiro; Iwai Naoto; Ueda Tomohiro; Hirose Ryohei; Inoue Ken; Yoshida Naohisa; Kamada Kazuhiro; Uchiyama Kazuhiko; Ishikawa Takeshi; Takagi Tomohisa; Konishi Hideyuki; Itoh Yoshito;

  • 作者单位

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

    Kyoto Prefectural Univ Med Dept Mol Gastroenterol &

    Hepatol Grad Sch Med Sci Kyoto Japan;

  • 收录信息
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 消化系及腹部疾病;
  • 关键词

    Gastric cancer; Antithrombotic agent; Endoscopic submucosal dissection; Gastrointestinal bleeding;

    机译：None;

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