Clinical management of esophagogastroduodenoscopy by clinicians under the former guidelines of the Japan Gastroenterological Endoscopy Society for patients taking anticoagulant and antiplatelet medications
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- 作者：Kunio Iwatsuka ; Takuji Gotoda ; Chika Kusano ; Masakatsu Fukuzawa…
- 关键词：Antithrombotic drug ; Anticoagulant drug ; Antiplatelet drug ; Drug cessation ; Esophagogastroduodenoscopy
- 刊名：Gastric Cancer
- 出版年：2014
- 出版时间：October 2014
- 年：2014
- 卷：17
- 期：4
- 页码：680-685
- 全文大小：425 KB
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Takuji Gotoda (1)
Chika Kusano (1)
Masakatsu Fukuzawa (1)
Katsutoshi Sugimoto (1)
Takao Itoi (1)
Takashi Kawai (2)
Fuminori Moriyasu (1)
1. Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
2. Endoscopy Center, Tokyo Medical University, Tokyo, Japan - ISSN：1436-3305
文摘
Background The 2005 Japan Gastroenterological Endoscopy Society (JGES) guidelines for the management of antithrombotic drugs focused on the increasing risks of bleeding, even from biopsy during scheduled esophagogastroduodenoscopy (EGD). The new 2012 guidelines emphasized the prevention of thromboembolic complications. To compare with the new guidelines, we investigated the clinical management of EGD by clinicians under the former JGES guidelines for patients taking antithrombotic agents. Methods Medical records of 4574 patients (mean age 63.4?years, range 3-6?years, male/female ratio 2805/1769) who underwent scheduled EGD from April 2011 to March 2012 were reviewed retrospectively. The prescribed agents, pre-existing comorbidities, drug cessation before EGD, bleeding, and thromboembolic complications were investigated. Results Five hundred forty-six patients (12.0?%) were taking antithrombotic drugs (aspirin, 313; warfarin, 134; cilostazol, 57; clopidogrel, 59; ethylicosapentate, 40; prostaglandin preparations, 41; ticlopidine, 29; icosapentate, 24; dipyridamole, 4); 116 and 29 patients, respectively, were managed with a combination of 2 or 3 agents. Among 490 patients whose medical records were precisely documented, 40.6?% underwent EGD without cessation. Bleeding and thromboembolic complications were not observed. The most common pre-existing comorbidity was ischemic heart disease (27.9?%), followed by carotid or intracranial large artery atherosclerosis (20.5?%), cerebral infarction or transient ischemic attack (20.3?%), and atrial fibrillation (15.9?%). Patients with pre-existing comorbidity requiring anticoagulants frequently underwent EGD without cessation. Conclusion We revealed the low impact of the 2005 JGES guidelines on the management of antithrombotic drugs. Our physicians have reasonably decided to continue antithrombotic drugs before EGD according to the risk of thromboembolism.