老年患者消化道内镜围术期抗栓药物管理的回顾性研究

Management of antithrombotic agents for endoscopic procedures in elderly Chinese patients:a retrospective study

目的:研究住院接受消化道内镜术的老年患者围术期抗栓药物管理方案及不良事件,为老年患者消化道内镜围术期抗栓药物使用、管理提供临床指导与借鉴。方法:回顾性研究2008年1月1日-2014年12月31日在中国人民解放军总医院住院接受择期消化道内镜检查/操作的患者,共计3 747例患者入选,其中男性3 601例(96.1%),年龄(46~99)岁,大于等于60岁患者共3 458例(92.3%)。记录患者一般临床情况、心血管疾病及危险因素、用药、围术期抗栓药物调整方案和不良事件发生情况等临床资料。统计术前停用不同抗栓药物的时间以及术后恢复抗栓药物的不同时间患者之间在消化道内镜围术期内发生血栓栓塞及出血事件的差异。结果:本研究人群中,消化道内镜围术期总体血栓栓塞事件发生率和出血事件发生率分别为2.24%和1.89%,其中消化道内镜术前0~7 d停用抗栓药物发生血栓栓塞1.87%、出血2.38%,内镜术后2~7 d恢复抗栓药物发生血栓栓塞2.07%、出血0.63%。在停用抗栓药物期间,未应用低分子肝素抗凝桥接治疗和应用低分子肝素抗凝药物桥接治疗患者的血栓栓塞事件的发生率之间无统计学差异,出血事件的发生率高于未应用抗凝药物桥接治疗的患者,两者之间无统计学差异。结论:老年患者中,在消化道内镜术前停用抗栓药物<7 d,在术后2~7 d以内恢复抗栓药物,可同时减少围术期血栓栓塞事件和出血事件发生的风险,是合理的抗栓药物管理策略。

Objective： To investigate the peri-endoscopic management of antithrombotic drugs and adverse events in elderly patients tm- dergoing gastrointestinal endoscopy in order to provide clinical guidance of peri-endoscopic management of antithrombotic drugs for elderly patients. Methods： Between January 1st 2008 and December 31st 2014, clinical data of 3 747 patients （aged 46- 99 years, 96.1% male） who were hospitalized for elective gastrointestinal endoscopy were analyzed retrospectively. The general clinical data, cardiovascular disease and related risk factors, medication, management of peri-endoscopic antithromboties and adverse events were recorded. The differences of peri-endo-scopic adverse events including thromboembolism and bleeding between patients with different management strategies of peri-endoscopic antithrombotics were analyzed. Results： The overall incidences of peri-endoscopic thromboembolism and bleeding were 2.24 % and 1.89 %, respectively. The incidences of thromboembolism and bleeding when stopping antithrombotics at 0-7 days pre-procedure were 1.87 % and 2.38% respectively. The incidences of thromboembolism and bleeding when resuming antithrombotics at 2- 7 days after endoscopy were 2.07% and 0.63% respectively. When discontinuing antithromboties, the differences in peri-endoscopie thrombolism and bleding between patients who did and did not andergo low-molecular-weight heparin （LMWH） bridging therapy were not significant. The incidence of bleeding in patients who underwent LMWH bridging therapy was higher than that in patients who didn＇ t undergo LMWH bridging therapy, but the diference was not significant. Conclusion： Our findings suggest that cessation of antithrombotics 〈 7 days pre-procedures and resumption of antithrombotic agents after 2-7 days post-porcedures is optimal in elderly Chinese patients undergoing endoscopy.