| 特集名 | 大腸内視鏡のリスクマネジメント | |
|---|---|---|
| 題名 | 総論（2）抗血小板薬・抗凝固薬の取り扱い | |
| 発刊年月 | 2016年 11月 | |
| 著者 | 髙島 健司 | 国立がん研究センター東病院消化管内視鏡科 |
| 著者 | 池松 弘朗 | 国立がん研究センター東病院消化管内視鏡科 |
| 【 要旨 】 | 2012年7月に日本消化器内視鏡学会によって「抗血栓薬服用者に対する消化器内視鏡ガイドライン」が改訂されたが，その内容は，血栓塞栓症と比較し消化管出血は臨床的に許容可能なことが多く，従来のガイドラインより血栓塞栓症の予防を重視する内容となった． 改訂されたガイドラインで，内視鏡の生検は，抗血栓薬の継続が可能となり，内視鏡治療においても低用量のアスピリンの継続が可能とされた． 本稿では，日本消化器内視鏡学会のガイドラインにおける大腸内視鏡検査および治療時の抗血栓薬の取り扱いについて解説する． |
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| Theme | Risk Management in Colonoscopy | |
|---|---|---|
| Title | Management of Anticoagulation and Antiplatelet Therapy in Colonoscopic Treatment | |
| Author | Kenji Takashima | Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East |
| Author | Hiroaki Ikematsu | Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East |
| [ Summary ] | In 2012, the Japan Gastroenterological Endoscopy Society (JGES) revised the gastroenterological endoscopy guidelines for patients receiving anticoagulant therapy. The guidelines focus on the prevention of thromboembolism. The Japanese guidelines recommend colonoscopic biopsies without interruption of anticoagulant therapy and colonoscopic treatment (polypectomy, endoscopic mucosal resection [EMR], and endoscopic submucosal dissection [ESD]), with continuing low?dose aspirin therapy in patients. Colonoscopic treatment causes post?operative bleeding at a constant rate. Previous studies have reported that the post?operative bleeding rate was approximately 1.0?1.7 % after polypectomy and EMR and approximately 1.0?2.8 % after ESD. In clinical practice, endoscopists need to balance the risks of hemorrhage after colonoscopic treatment and thromboembolic events. However, data supporting these strategies are insufficient. In this report, I have discussed the management of anticoagulation and antiplatelet therapy in colonoscopic biopsies and treatment. |
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