日本胃肠内镜黏膜下切除术中直接口服抗凝药物类型导致的结直肠内镜黏膜下切除术延迟性出血分析。
An analysis of delayed bleeding in cases of colorectal endoscopic submucosal dissection due to types of direct oral anticoagulants in Japan.
发表日期：2023 Sep 22
作者：
Naohisa Yoshida, Yoshikazu Hayashi, Daichi Togo, Shiro Oka, Kazunori Takada, Shusei Fukunaga, Yoshinori Morita, Takemasa Hayashi, Kazuhiro Kozuka, Yosuke Tsuji, Takashi Murakami, Takeshi Yamamura, Yoriaki Komeda, Yoji Takeuchi, Kensuke Shinmura, Hiroko Fukuda, Shinji Yoshii, Shoko Ono, Shinichi Katsuki, Kazumasa Kawashima, Daiki Nemoto, Hiroyuki Yamamoto, Yutaka Saito, Naoto Tamai, Aya Iwao, Yuki Itoi, Shigetsugu Tsuji, Yoshikazu Inagaki, Yutaka Inada, Koichi Soga, Daisuke Hasegawa, Takaaki Murakami, Hiroyuki Yoriki, Kohei Fukumoto, Takayuki Motoyoshi, Yasuki Nakatani, Yasushi Sano, Mikitaka Iguchi, Shigehiko Fujii, Hiromitsu Ban, Keita Harada, Koichi Okamoto, Hitoshi Nishiyama, Fumisato Sasaki, Kazujhiro Mizukami, Takashi Shono, Ryo Shimoda, Tadashi Miike, Naoyuki Yamaguchi
来源：
MOLECULAR & CELLULAR PROTEOMICS
摘要：
报告显示，使用直接口服抗凝剂（DOAC）进行内窥镜切除术后的延迟出血（DB）率高且异质性较大。本项大规模多中心研究（ABCD-J研究）分析了与日本多种DOAC相关的结直肠内窥镜下粘膜切除术后的DB病例，与华法林相关的病例进行比较。我们回顾性地审查了来自47个日本机构的34,455例内窥镜下粘膜切除术中使用DOAC治疗的1,019个病变和使用华法林治疗的459个病变。比较了每种DOAC与华法林的DB发生率（DBR）。同时还研究了使用DOAC或华法林治疗的患者的DB风险因素。
DOAC组和华法林组的平均肿瘤大小分别为29.6±14.0 mm和30.3±16.4 mm。在DOAC组中，达比加群（18.26%）的DBR显著高于阿比哌沙群（10.08%，P = .029）、厄多沙群（7.73%，P=.001）和利伐沙群（7.21%，P<.001）。只有利伐沙群的DBR明显低于华法林群（11.76%，P=.033）。在多变量分析中，肝素桥接治疗（比值比 [OR]，95%可信区间 [CI]：2.18，1.27-3.73，P=.005）、直肠部位（2.01，1.28-3.16，P=.002）和手术时间≥55分钟（2.43，1.49-3.95，P<.001）是DOAC组DB的显著风险因素。DOAC组的DB风险（OR，（95% CI））分别为1个和2个显著风险因素时为2.13（1.30-3.50）和4.53（2.52-8.15）。
达比加群的DBR高于其他DOAC组，而只有利伐沙群的DBR明显低于华法林。
版权所有 © 2023 AGA Institute。由Elsevier Inc.出版。保留所有权利。
Reported rates of delayed bleeding (DB) after endoscopic resection using direct oral anticoagulants (DOACs) are high and heterogeneous. This large-scale multicenter study analyzed cases of DB after colorectal endoscopic submucosal dissection related to various types of DOACs in Japan (the ABCD-J study) with those associated with warfarin.We retrospectively reviewed 1,019 lesions in patients treated with DOACs and 459 lesions in patients treated with warfarin among 34,455 ESD cases from 47 Japanese institutions between 2012 and 2021. The DB rate (DBR) with each DOAC was compared with that with warfarin. Risk factors for DB in patients treated with DOACs or warfarin were also investigated.The mean tumor sizes in the DOAC and warfarin groups were 29.6±14.0 and 30.3±16.4 mm, respectively. In the DOAC group, the DBR with dabigatran (18.26%) was significantly higher than that with apixaban (10.08%, P = .029), edoxaban (7.73%, P=.001), and rivaroxaban (7.21%, P<.001). Only rivaroxaban showed a significantly lower DBR than warfarin (11.76%; P=.033). In the multivariate analysis, heparin bridging therapy (odds ratio [OR], 95% confidence interval [CI]: 2.18, 1.27-3.73, P=.005), rectal location (2.01, 1.28-3.16, P=.002), and procedure time ≥55 min (2.43, 1.49-3.95, P<.001) were significant risk factors for DB in the DOAC group. The DB risk in the DOAC group (OR, (95% CI)) was 2.13 (1.30-3.50) and 4.53 (2.52-8.15) for 1 and 2 significant risk factors, respectively.Dabigatran was associated with a higher DBR than other DOACs, and only rivaroxaban was associated with a significantly lower DBR than warfarin.Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.