| 特集名 | 大腸内視鏡治療と抗血栓薬─新ガイドラインの妥当性 | |
|---|---|---|
| 題名 | ガイドライン改訂後の現状 ─ 消化器専門医の本音 | |
| 発刊年月 | 2014年 09月 | |
| 著者 | 東 玲治 | 地方独立行政法人広島市立病院機構広島市立広島市民病院内科 |
| 著者 | 國弘 真己 | 地方独立行政法人広島市立病院機構広島市立広島市民病院内科 |
| 著者 | 山邊 徹 | 地方独立行政法人広島市立病院機構広島市立広島市民病院内科 |
| 著者 | 藤井 佑樹 | 地方独立行政法人広島市立病院機構広島市立広島市民病院内科 |
| 著者 | 大林 由佳 | 地方独立行政法人広島市立病院機構広島市立広島市民病院内科 |
| 著者 | 平尾 謙 | 地方独立行政法人広島市立病院機構広島市立広島市民病院内科 |
| 著者 | 小川 恒由 | 地方独立行政法人広島市立病院機構広島市立広島市民病院内科 |
| 著者 | 中川 昌浩 | 地方独立行政法人広島市立病院機構広島市立広島市民病院内視鏡内科 |
| 著者 | 水野 元夫 | 地方独立行政法人広島市立病院機構広島市立広島市民病院内科 |
| 【 要旨 】 | 超高齢社会の到来と食生活の欧米化により，動脈硬化に起因する疾患が増加し，抗血栓薬服用中の患者に大腸内視鏡治療を施行する機会が増加している．内視鏡治療における抗血栓薬の取り扱いに関するガイドラインは，2012年に血栓塞栓症の誘発に配慮したものに改訂された．ガイドライン改訂前後での当院における大腸内視鏡治療では，抗血栓薬継続下での施行が有意に増加したが，切除ポリープ数や抗血栓薬内服率，後出血率に有意な差は認めなかった．大腸内視鏡治療後出血のリスク因子を検討すると，抗血小板薬内服はリスクではなく，抗凝固薬内服のみが独立したリスク因子であった．さらに，抗凝固薬からのヘパリン置換症例で内視鏡止血困難な後出血を経験しており，慎重な対応が必要であると考える． | |
| Theme | Management of antithrombotic agents for colorectal endoscopic procedures -- Validity of new guideline by Japan Gastroenterological Endoscopy Society | |
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| Title | Current status of revised guidelines -- Real intention of gastroenterologists | |
| Author | Reiji Higashi | Department of Internal Medicine, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| Author | Masaki Kunihiro | Department of Internal Medicine, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| Author | Toru Yamabe | Department of Internal Medicine, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| Author | Yuki Fujii | Department of Internal Medicine, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| Author | Yuka Oobayashi | Department of Internal Medicine, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| Author | Ken Hirao | Department of Internal Medicine, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| Author | Tsuneyoshi Ogawa | Department of Internal Medicine, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| Author | Masahiro Nakagawa | Department of Endoscopy, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| Author | Motowo Mizuno | Department of Internal Medicine, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital |
| [ Summary ] | Growth of our elderly population and westernization of our diet have led to a rise in the number of patients with atherosclerotic diseases in Japan. Endoscopists are facing increased opportunities to perform colonoscopic treatment on patients who are receiving antithrombotic agents. The guidelines on management of antithrombotic agents for patients undergoing colonoscopic treatment was renewed in 2012, in order to address the importance of avoiding thromboembolic complications from discontinuing antithrombotic agents. The number of patients who underwent colonoscopic treatment while continuing antithrombotic agents increased significantly after the issuance of the new guidelines. The number of resected polyps, the prevalence of antithrombotic agent use, and the frequency of delayed bleeding did not change significantly. Our analysis of the risk factors associated with delayed bleeding connected with colonoscopic treatment indicates that the use of antiplatelet agents is not a risk factor. The only independent risk factor was the use of anticoagulant agents. Moreover, at our center, we experienced a case in which a patient, whose anticoagulant was replaced with heparin before treatment, had bleeding that was uncontrollable endoscopically. We strongly suggest that anticoagulant agents for patients undergoing colonoscopic treatment must be managed extremely cautiously. |
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