THER ADV GASTROENTER:结直肠息肉行冷圈套切除术的患者围手术期抗血栓药物安全性分析

2022-02-26 MedSci原创 MedSci原创

结直肠癌(CRC)在肿瘤相关死亡率的病因中高居第三位。根据腺瘤 - 肿瘤途径学说,切除结肠息肉可以降低 CRC 的风险。然而,内镜下结肠息肉切除术的潜在并发症包括消化道穿孔、消化道出血及电凝综合征等。

由于卓越的疗效和安全性,冷圈套器息肉切除术(CSP)是临床指南中推荐的≥10 mm 的结直肠息肉的标准治疗方法。与热圈套器息肉切除术 (HSP) 相比,CSP 比 HSP 需要更多的浅表切割但是对粘膜下动脉的损伤更少,从而最大限度地减少不良事件,如穿孔和延迟出血。尽管 CSP 的安全性已普遍接受,但尚未在围手术期使用抗血栓药物(包括抗血小板和抗凝剂)的患者中得到充分证实。传统上,息肉切除术被认为具有较高的出血风险(>1%);因此,目前的指南建议在围手术期停用除阿司匹林外的抗血栓药物。然而,这些建议是否适用于 CSP 切除小结直肠息肉尚不清楚。因此,本项研究旨在探讨 CSP 在使用和不使用抗血栓药物的情况下的出血和血栓栓塞风险。

研究人员为了完成本项研究,检索了截至 2021 年 6 月的 PubMed、Embase 和 Cochrane 数据库。主要观察结果是延迟和立即出血的发生率(需要内镜止血)。次要观察结局包括血栓栓塞事件。使用优势比 (OR) 和相应的 95% 置信区间 (CI) 进行荟萃分析以比较结果差异。

 

本项荟萃分析总共纳入了 17 项研究,包括 5 项随机试验。超过 96% 的息肉为 1 cm。接受 CSP 和围手术期抗血栓药物治疗的患者延迟和立即出血的合并率分别为 1.6% 和 10.5%。使用围手术期抗血栓药物的患者的延迟(OR = 4.02, 95% CI = 1.98-8.17)和即刻出血(OR = 5.85, 95% CI = 3.84-8.89)率均显着高于非使用者。尽管抗血小板药物和抗凝剂都增加了延迟出血的风险,但与使用直接口服抗凝剂(DOAC;2.5%)或多种药物(3.9%)相关的风险尤其高,较小的息肉和不需要血夹的不复杂病变与延迟出血的风险较低相关(合并估计分别为 0.4% 和 0.18%)。使用和未使用围手术期抗血栓药物的患者血栓栓塞风险相似。

 

本项研究证实围手术期使用抗血小板药物和华法林药物患者接受 CSP 是可行的,特别是对于小息肉。然而,在使用 DOAC 或多种药物时应考虑停药,即使使用止血夹也会带来更高的出血风险。

原始出处:

Jen-Hao Yeh. et al. Safety of cold snare polypectomy with periprocedural antithrombotic agents for colorectal polyps: a systematic review and meta-analysis. Therapeutic Advances in Gastroenterology.2022.

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[GetPortalCommentsPageByObjectIdResponse(id=1877555, encodeId=0dde18e755540, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Fri Jul 15 09:15:02 CST 2022, time=2022-07-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1994427, encodeId=3a3d199442e7f, content=<a href='/topic/show?id=4d0655e6226' target=_blank style='color:#2F92EE;'>#抗血栓药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55762, encryptionId=4d0655e6226, topicName=抗血栓药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f5e185, 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createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ace5575596, createdName=crystal0564, createdTime=Mon Feb 28 04:15:02 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486755, encodeId=28d81486e558b, content=<a href='/topic/show?id=b1d8e868430' target=_blank style='color:#2F92EE;'>#结直肠息肉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78684, encryptionId=b1d8e868430, topicName=结直肠息肉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=066c8204452, createdName=neurowu, createdTime=Mon Feb 28 04:15:02 CST 2022, time=2022-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574146, encodeId=fec715e414659, content=<a href='/topic/show?id=ee4955e5730' target=_blank style='color:#2F92EE;'>#抗血栓#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55757, encryptionId=ee4955e5730, topicName=抗血栓)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a26516008049, createdName=gwc388, createdTime=Mon Feb 28 04:15:02 CST 2022, time=2022-02-28, status=1, ipAttribution=)]
    2022-12-09 许安
  5. 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  6. 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  7. 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    2022-02-28 gwc388

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