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作 者:Andrew Chan Hamish Philpott Amanda H Lim Minnie Au Derrick Tee Damian Harding Mohamed Asif Chinnaratha Biju George Rajvinder Singh
机构地区:[1]Department of Gastroenterology,Lyell McEwin Hospital,Adelaide 5112,South Australia,Australia [2]School of Medicine,The University of Adelaide,Adelaide 5005,Australia
出 处:《World Journal of Gastrointestinal Endoscopy》2020年第11期408-450,共43页世界胃肠内镜杂志(英文版)(电子版)
摘 要:The role of endoscopic procedures,in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly.In this context,endoscopists will encounter patients prescribed on anticoagulant and antiplatelet medications frequently.This poses an increased risk of intraprocedural and delayed gastrointestinal bleeding.Thus,there is now greater importance on optimal pre,peri and post-operative management of anticoagulant and/or antiplatelet therapy to minimise the risk of post-procedural bleeding,without increasing the risk of a thromboembolic event as a consequence of therapy interruption.Currently,there are position statements and guidelines from the major gastroenterology societies.These are available to assist endoscopists with an evidenced-based systematic approach to anticoagulant and/or antiplatelet management in endoscopic procedures,to ensure optimal patient safety.However,since the publication of these guidelines,there is emerging evidence not previously considered in the recommendations that may warrant changes to our current clinical practices.Most notably and divergent from current position statements,is a growing concern regarding the use of heparin bridging therapy during warfarin cessation and its associated risk of increased bleeding,suggestive that this practice should be avoided.In addition,there is emerging evidence that anticoagulant and/or antiplatelet therapy may be safe to be continued in cold snare polypectomy for small polyps(<10 mm).
关 键 词:Endoscopy ANTICOAGULANTS ANTIPLATELETS ANTITHROMBOTICS BLEEDING Gastrointestinal
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