摘要
目的 探讨应用抗栓药物对内镜黏膜下剥离术（ESD）术后出血的影响.方法 检索1990 年1 月至2014 年8 月Medline、Embase、Cochrane library、万方数据库、维普数据库及中国知网数据库发表的有关抗栓药物对ESD 术后出血影响的所有文献,通过纳入和排除标准筛选文献,评估ESD 围手术期抗栓药物不同应用方法对术后出血的影响,采用RevMan 5.1 软件进行Meta 分析.结果 最终纳入15 篇研究.Meta 分析显示,持续应用抗栓药物与从未服用抗栓药物（OR=0.36,95%CI0.22～0.59,P〈0.000 1）和术前停用抗栓药物（OR=0.43,95% CI：0.20～0.94,P=0.03）相比,大大增加了ESD 术后出血的风险,但后两者之间无明显差异（OR=0.67,95% CI：0.40～1.11,P=0.12）.术后2 d 即恢复使用抗栓药物（9.97%,73/732）、停药期间使用肝素/低分子肝素过渡治疗（9.90%,82/828）以及同时使用2 种或2 种以上抗栓药物（13.31%,39/293）都会明显增加术后出血的风险.结论 ESD 术前停用抗栓药物可以降低术后出血的风险,但过早恢复服用抗栓药物、使用肝素/低分子肝素过渡或联用多种抗栓药物都会使出血风险相对增加,将来还需要进一步的随机对照研究来证实。
Objective To assess the bleeding risk after endoscopic submucosal dissection(ESD) in patients with antithrombotic agents, including antiplatelet drugs and anticoagulants. Methods Papers published from January 1990 to August 2014 in Medline, Embase, Cochrane library, Wanfang, VIP and CNKI were searched to identify the studies evaluating whether antithrombotic agents used were associated with post-ESD bleeding risk. Statistic analyses were carried out using RevMan 5.1 software. Results A total of 15 studies were included in this Meta-analysis. Analysis of these studies found that post-ESD bleeding was more frequent in continuous antithrombotic agents users than in those who never used antithrombotic agents (OR=0.36, 95% CI: 0.22-0.59, P<0.000 1) and those with interrupted antithrombotic agents use (OR=0.43, 95% CI: 0.20-0.94, P=0.03), but there was no significant difference between the latter two groups (OR=0.67, 95% CI: 0.40-1.11, P=0.12). However, we found that if antithrombotic agents were restarted on day 2 after ESD (9.97%, 73/732) or switched to unfractionated heparin(UFH) and low molecular weight heparin (LMWH) as bridging therapy (9.90%, 82/828) or used two or more antithrombotic agents (13.31%, 39/293) will increase post-ESD bleeding significantly. Conclusion Interruption of antithrombotic agents may be adequate for preventing post-ESD bleeding, however, reinitiating antithrombotic agents too early, using bridge therapy or taking two or more antithrombotic agents will increase the bleeding risk.
出处
《中华临床医师杂志（电子版）》
CAS
2015年第22期85-89,共5页
Chinese Journal of Clinicians(Electronic Edition)
关键词
META分析
血小板聚集抑制剂
抗凝药
内镜黏膜下剥离术
抗栓药
Meta-analysis
Platelet aggregation inhibitors
Anticoagulants
Endoscopic submucosal dissection
Antithrombotic agents
