How should patients requiring dual antiplatelet therapy be managed when undergoing elective endoscopic gastrointestinal procedures?

被引：1
作者：
Sherwood M.W. [1 ]
Wang T.Y. [1 ]
Becker R.C. [1 ]
机构：
[1] Division of Cardiology, Duke University School of Medicine, DUMC 3850, Durham
来源：
Current Treatment Options in Cardiovascular Medicine | 2011年 / 13卷 / 1期
关键词：
Aspirin; Percutaneous Coronary Intervention; Clopidogrel; Omeprazole; Stent Thrombosis;
D O I：
10.1007/s11936-010-0107-4
中图分类号：
学科分类号：
摘要：
Opinion statement: The following are general guidelines for the management of patients on dual antiplatelet therapy as they undergo gastrointestinal procedures with potential for bleeding complications: Avoid cessation of all antiplatelet therapies after percutaneous coronary intervention (PCI) with stent placement when possible. Avoid cessation of clopidogrel (even when aspirin is continued) within the first 30 days after PCI and either drug-eluting stent (DES) or bare metal stent placement. Defer elective endoscopic procedures, possibly up to 12 months, if clinically acceptable from the time of PCI and DES placement. Perform endoscopic procedures, particularly those associated with bleeding risk, 5 to 7 days after thienopyridine drug cessation. Aspirin should be continued when possible. Resume thienopyridine and aspirin drug therapy after the procedure once hemostasis is achieved. A loading dose of the former should be considered among patients at risk for thrombosis. Continue platelet-directed therapy in patients undergoing elective endoscopy procedures associated with a low risk for bleeding. © 2010 Springer Science+Business Media, LLC.
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页码：46 / 56
页数：10
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共 48 条
  • [31] Bhatt D.L., Cryer B.L., Contant C.F., Et al., Clopidogrel with or without omperazole in coronary artery disease, N Engl J Med, 363, pp. 1909-1917, (2010)
  • [32] Arrowsmith J.B., Gerstman B.B., Fleischer D.E., Benjamin S.B., Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy, Gastrointest Endosc, 37, pp. 421-427, (1991)
  • [33] Rogers B.H., Silvis S.E., Nebel O.T., Sugawa C., Mandelstam P., Complications of flexible fiberoptic colonoscopy and polypectomy, Gastrointest Endosc, 22, pp. 73-77, (1975)
  • [34] Alam M., Schuman B.M., Duvernoy W.F., Madrazo A.C., Continuous electrocardiographic monitoring during colonoscopy, Gastrointest Endosc, 22, pp. 203-205, (1976)
  • [35] Gupta S.C., Gopalswamy N., Sarkar A., Suryaprasad A.G., Markert R.J., Cardiac arrhythmias and electrocardiographic changes during upper and lower gastrointestinal endoscopy, Mil Med, 155, pp. 9-11, (1990)
  • [36] Marsh W.H., Bronner M.H., Yantis P.L., Kilgore J.W., Rickoff M.I., Ventricular ectopy associated with peroral colonic lavage, Gastrointest Endosc, 32, pp. 259-263, (1986)
  • [37] Rabeneck L., Paszat L.F., Hilsden R.J., Et al., Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice, Gastroenterology, 135, pp. 1899-1906, (2008)
  • [38] Nelson D.B., McQuaid K.R., Bond J.H., Lieberman D.A., Weiss D.G., Johnston T.K., Harford W.V., Ahnen D.J., Provenzale D., Sontag S.J., Schnell T.G., Campbell D.R., Durbin T.E., Lee J.G., Triadafilopoulos G., Ramirez F.C., Collins J.F., Fennerty M.B., Garewal H., Sampliner R.E., Morales T.G., Fass R., Smith R.E., Maheshwari Y., Procedural success and complications of large-scale screening colonoscopy, Gastrointestinal Endoscopy, 55, 3, pp. 307-314, (2002)
  • [39] Watabe H., Yamaji Y., Okamoto M., Kondo S., Ohta M., Ikenoue T., Kato J., Togo G., Matsumura M., Yoshida H., Kawabe T., Omata M., Risk assessment for delayed hemorrhagic complication of colonic polypectomy: Polyp-related factors and patient-related factors, Gastrointestinal Endoscopy, 64, 1, pp. 73-78, (2006)
  • [40] Tolliver K.A., Rex D.K., Colonoscopic Polypectomy, Gastroenterology Clinics of North America, 37, 1, pp. 229-251, (2008)
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