Management of Antithrombotic Agents During Emergency Endoscopy for Upper Gastrointestinal Bleeding: A Propensity Score Matching Analysis

GastroHep Pub Date : 2024-06-30 DOI:10.1155/2024/7561793

Daisuke Yamaguchi, Satoshi Ishida, Kasumi Gondo, Tadahiro Nomura, Azuki Yamaguchi, Ryosuke Asahi, Yumi Mizuta, Goshi Nagatsuma, Shota Fukami, Shunichiro Kimura, Shun Fujimoto, Akane Shimakura, Amane Jubashi, Yuki Takeuchi, Kei Ikeda, Yuichiro Tanaka, Wataru Yoshioka, Naoyuki Hino, Tomohito Morisaki, Keisuke Ario, Seiji Tsunada

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Abstract

Background/Aims: This study is aimed at comparing the outcomes of upper gastrointestinal bleeding (UGIB) during emergency endoscopy between patients taking and not taking antithrombotic agents to inform antithrombotic management.

Methods: We conducted a retrospective analysis of 389 patients who underwent emergency endoscopy for UGIB from 2016 to 2021. The patients were categorized into group A (taking antithrombotic agents) and group NA (not taking antithrombotic agents). The clinical characteristics, types of antithrombotic agents, patient status upon admission, and causes of UGIB were examined. Treatment outcomes and adverse events were assessed by propensity score matching (PSM).

Results: Group A was significantly older and the primary antithrombotic agent was low-dose aspirin, with multiple antithrombotics taken by 38 patients (29.0%). Peptic ulcers were the most common cause of UGIB in both groups. PSM generated 83 matched pairs. The success rate of endoscopic hemostasis in group A was significantly higher than in group NA (96.4% vs. 84.3%, P = 0.02). Despite promptly resuming antithrombotic agent posthemostasis, there was no significant difference in the rebleeding rate or 30-day mortality.

Conclusion: The high success rate of endoscopic hemostasis and no difference in adverse events made the prompt resumption of antithrombotic medications after emergency endoscopy for UGIB acceptable.

Trial Registration: ClinicalTrials.gov identifier: UMIN000053561

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上消化道出血急诊内镜检查期间的抗血栓药物管理：倾向得分匹配分析

背景/目的：本研究旨在比较服用和未服用抗血栓药物的患者在急诊内镜检查期间发生上消化道出血（UGIB）的结果，为抗血栓治疗提供参考：我们对 2016 年至 2021 年期间因 UGIB 而接受急诊内镜检查的 389 名患者进行了回顾性分析。患者被分为A组（服用抗血栓药物）和NA组（未服用抗血栓药物）。研究人员对患者的临床特征、抗血栓药物类型、入院时的状态以及导致 UGIB 的原因进行了调查。通过倾向得分匹配法（PSM）对治疗结果和不良事件进行了评估：结果：A 组患者年龄明显偏大，主要抗血栓药物为小剂量阿司匹林，38 名患者（29.0%）服用了多种抗血栓药物。消化性溃疡是两组 UGIB 最常见的病因。PSM 产生了 83 对配对。A 组的内镜止血成功率明显高于 NA 组（96.4% 对 84.3%，P = 0.02）。尽管止血后及时恢复使用抗血栓药物，但再出血率和30天死亡率没有显著差异：结论：内镜止血成功率高，且不良反应无差异，因此UGIB急诊内镜术后及时恢复抗血栓药物治疗是可以接受的：试验注册：ClinicalTrials.gov identifier：UMIN000053561

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GastroHep

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