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Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy

조주영|민병훈|박찬국|Miyoung Choi|이수택|공은정|김호각|Jeong-Sik Byeon|Seung Joo Kang|Cheol Min Shin|Hoon Jai Chun|임현
대한소화기내시경학회 (The Korean Society Of Gastrointestinal Endoscopy)|2020.11|Clinical Endoscopy|제53권 제6호|pp. 663-677|DOI doi.org/10.5946/ce.2020.192

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참고문헌

키워드

GuidelinesAdaptationAnticoagulantsEndoscopyAntiplatelet agents
주제분류내과학

초록

Antithrombotic agents, including antiplatelet agents and anticoagulants, are increasingly used in South Korea. The managementof patients using antithrombotic agents and requiring gastrointestinal endoscopy is an important clinical challenge. Althoughclinical practice guidelines (CPGs) for the management of patients receiving antithrombotic agents and undergoing gastrointestinalendoscopy have been developed in the Unites States, Europe, and Asia Pacific region, it is uncertain whether these guidelines canbe adopted in South Korea. After reviewing current CPGs, we identified unmet needs and recognized significant discrepanciesin the clinical practice among regions. This is the first CPG in Korea providing information that may assist endoscopists in themanagement of patients on antithrombotic agents who require diagnostic or elective therapeutic endoscopy. This guideline wasdeveloped through the adaptation process as an evidence-based method, with four guidelines retrieved by systematic review. Eligibleguidelines were evaluated according to the Appraisal of Guidelines for Research and Evaluation II process, and 13 statements wereestablished using a grading system. This guideline was reviewed by external experts before an official. It will be revised as necessaryto cover changes in technology, evidence, or other aspects of clinical practice.

Abstract

Antithrombotic agents, including antiplatelet agents and anticoagulants, are increasingly used in South Korea. The managementof patients using antithrombotic agents and requiring gastrointestinal endoscopy is an important clinical challenge. Althoughclinical practice guidelines (CPGs) for the management of patients receiving antithrombotic agents and undergoing gastrointestinalendoscopy have been developed in the Unites States, Europe, and Asia Pacific region, it is uncertain whether these guidelines canbe adopted in South Korea. After reviewing current CPGs, we identified unmet needs and recognized significant discrepanciesin the clinical practice among regions. This is the first CPG in Korea providing information that may assist endoscopists in themanagement of patients on antithrombotic agents who require diagnostic or elective therapeutic endoscopy. This guideline wasdeveloped through the adaptation process as an evidence-based method, with four guidelines retrieved by systematic review. Eligibleguidelines were evaluated according to the Appraisal of Guidelines for Research and Evaluation II process, and 13 statements wereestablished using a grading system. This guideline was reviewed by external experts before an official. It will be revised as necessaryto cover changes in technology, evidence, or other aspects of clinical practice.

참고문헌 (97)

  1. Antithrombotic Trialists’ Collaboration, "Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients", BMJ, 324, pp.71~86 (2002)
  2. Antithrombotic Trialists’ (ATT) Collaboration, "Aspirin in the primary and secondary prevention of vascular disease : collaborative meta-analysis of individual participant data from randomised trials", Lancet, 373, pp.1849~1860 (2009)
  3. Boston Area Anticoagulation Trial for Atrial Fibrillation Investigator, "The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation", N Engl J Med, 323, pp.1505~1511 (1990)
  4. van Walraven C, "Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation : an individual patient meta-analysis", JAMA, 288, pp.2441~2448 (2002)
  5. Choi KS, "EMR versus gastrectomy for intramucosal gastric cancer : comparison of long-term outcomes", Gastrointest Endosc, 73, pp.942~948 (2011)
  6. Pyo JH, "Long-term outcome of endoscopic resection vs. surgery for early gastric cancer : a non-inferiority-matched cohort study", Am J Gastroenterol, 111, pp.240~249 (2016)
  7. 김윤경, "Effects of Screening on Gastric Cancer Management: Comparative Analysis of the Results in 2006 and in 2011", Journal of Gastric Cancer, 14(2), pp.129~134 (2014), 대한위암학회[DOI]
  8. Holbrook A, "Evidence-based management of anticoagulant therapy : antithrombotic therapy and prevention of thrombosis, 9th ed : American College of Chest Physicians evidence-based clinical practice guidelines", Chest, 141(2 Suppl), pp.e152S~e184S (2012)
  9. Becker RC, "Management of platelet-directed pharmacotherapy in patients with atherosclerotic coronary artery disease undergoing elective endoscopic gastrointestinal procedures", J Am Coll Cardiol, 54, pp.2261~2276 (2009)
  10. Fujimoto K, "Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment", Dig Endosc, 26, pp.1~14 (2014)
  11. ASGE Standards of Practice Committee, "The management of antithrombotic agents for patients undergoing GI endoscopy", Gastrointest Endosc, 83, pp.3~16 (2016)
  12. Veitch AM, "Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants : British Society of Gastroenterology(BSG)and European Society of Gastrointestinal Endoscopy(ESGE)guidelines", Gut, 65, pp.374~389 (2016)
  13. Chan FKL, "Management of patients on antithrombotic agents undergoing emergency and elective endoscopy : joint Asian Pacific Association of Gastroenterology(APAGE)and Asian Pacific Society for Digestive Endoscopy(APSDE)practice guidelines", Gut, 67, pp.405~417 (2018)
  14. Brouwers MC, "AGREE II : advancing guideline development, reporting and evaluation in health care", CMAJ, 182, pp.E839~E842 (2010)
  15. Higgins JPT, "Cochrane handbook for systematic reviews of interventions. Version 5.1.0" (2011), Cochrane
  16. Sterne JA, "ROBINS-I : a tool for assessing risk of bias in non-randomised studies of interventions", BMJ, 355, pp.i4919~ (2016)
  17. Shea BJ, "Development of AMSTAR : a measurement tool to assess the methodological quality of systematic reviews", BMC Med Res Methodol, 7, pp.10~ (2007)
  18. Guyatt GH, "Incorporating considerations of resources use into grading recommendations", BMJ, 336, pp.1170~1173 (2008)
  19. "Recommendation for standard treatment for acute coronary syndrome" (2013)[URL]
  20. Levine GN, "2016 ACC", AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease : a report of the American College of Cardiology, AHA, pp.SCAI guideline for percutaneous coronary intervention, 2011 ACCF, AHA guideline for coronary artery bypass graft surgery, 2012 ACC[DOI]
  21. Egholm G, "Risk associated with surgery within 12 months after coronary drug-eluting stent implantation", J Am Coll Cardiol, 68, pp.2622~2632 (2016)
  22. Hawn MT, "Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents", JAMA, 310, pp.1462~1472 (2013)
  23. Holcomb CN, "The incremental risk of coronary stents on postoperative adverse events : a matched cohort study", Ann Surg, 263, pp.924~930 (2016)
  24. Valgimigli M, "2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS : The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology(ESC)and of the European Association for Cardio-Thoracic Surgery(EACTS)", Eur Heart J, 39, pp.213~260 (2018)
  25. Garcia DA, "Risk of thromboembolism with short-term interruption of warfarin therapy", Arch Intern Med, 168, pp.63~69 (2008)
  26. Blacker DJ, "Stroke risk in anticoagulated patients with atrial fibrillation undergoing endoscopy", Neurology, 61, pp.964~968 (2003)
  27. Cappell MS, "Management of gastrointestinal bleeding induced by gastrointestinal endoscopy", Gastroenterol Clin North Am, 29, pp.125~167 (2000)
  28. Macrae FA, "Towards safer colonoscopy : a report on the complications of 5000 diagnostic or therapeutic colonoscopies", Gut, 24, pp.376~383 (1983)
  29. Rogers BH, "Complications of flexible fiberoptic colonoscopy and polypectomy", Gastrointest Endosc, 22, pp.73~77 (1975)
  30. Vu CK, "Gastrointestinal bleeding after cold biopsy", Am J Gastroenterol, 93, pp.1141~1143 (1998)
  31. Wexner SD, "A prospective analysis of 13, 580colonoscopies. Reevaluation of credentialing guidelines", Surg Endosc, 15, pp.251~261 (2001)
  32. Parra-Blanco A, "Hemoclipping for postpolypectomy and postbiopsy colonic bleeding", Gastrointest Endosc, 51, pp.37~41 (2000)
  33. Sieg A, "Prospective evaluation of complications in outpatient GI endoscopy : a survey among German gastroenterologists", Gastrointest Endosc, 53, pp.620~627 (2001)
  34. Ono S, "Evaluation of safety of endoscopic biopsy without cessation of antithrombotic agents in Japan", J Gastroenterol, 47, pp.770~774 (2012)
  35. Whitson MJ, "Is gastroduodenal biopsy safe in patients receiving aspirin and clopidogrel? : a prospective, randomized study involving 630 biopsies", J Clin Gastroenterol, 45, pp.228~233 (2011)
  36. Ono S, "Retrospective analysis on the management of anticoagulants and antiplatelet agents for scheduled endoscopy", J Gastroenterol, 44, pp.1185~1189 (2009)
  37. Shiffman ML, "Risk of bleeding after endoscopic biopsy or polypectomy in patients taking aspirin or other NSAIDS", Gastrointest Endosc, 40, pp.458~462 (1994)
  38. Hamada T, "Bleeding after endoscopic sphincterotomy or papillary balloon dilation among users of antithrombotic agents", Endoscopy, 47, pp.997~1004 (2015)
  39. Bowles CJ, "A prospective study of colonoscopy practice in the UK today : are we adequately prepared for national colorectal cancer screening tomorrow?", Gut, 53, pp.277~283 (2004)
  40. Gavin DR, "The national colonoscopy audit : a nationwide assessment of the quality and safety of colonoscopy in the UK", Gut, 62, pp.242~249 (2013)
  41. Choung BS, "Incidence and risk factors of delayed postpolypectomy bleeding : a retrospective cohort study", J Clin Gastroenterol, 48, pp.784~789 (2014)
  42. Kim JH, "Risk factors for delayed post-polypectomy hemorrhage : a case-control study", J Gastroenterol Hepatol, 28, pp.645~649 (2013)
  43. Manocha D, "Bleeding risk after invasive procedures in aspirin", NSAID users : polypectomy study in veterans, 2012, pp.125, 1222~1227
  44. Repici A, "Safety of cold polypectomy for <10mm polyps at colonoscopy : a prospective multicenter study", Endoscopy, 44, pp.27~31 (2012)
  45. Rutter MD, "Risk factors for adverse events related to polypectomy in the English bowel cancer screening programme", Endoscopy, 46, pp.90~97 (2014)
  46. Hui AJ, "Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents : analysis of 1657 cases", Gastrointest Endosc, 59, pp.44~48 (2004)
  47. Yousfi M, "Postpolypectomy lower gastrointestinal bleeding : potential role of aspirin", Am J Gastroenterol, 99, pp.1785~1789 (2004)
  48. 이석호, "Korean Guideline for Colonoscopic Polypectomy", Clinical Endoscopy, 45(1), pp.11~24 (2012), 대한소화기내시경학회[DOI]
  49. 문희석, "Only the Size of Resected Polyps Is an Independent Risk Factor for Delayed Postpolypectomy Hemorrhage: A 10-Year Single-Center Case-Control Study", Annals of Coloproctolgy, 30(4), pp.182~185 (2014), 대한대장항문학회
  50. Shalman D, "Systematic review with meta-analysis : the risk of gastrointestinal haemorrhage post-polypectomy in patients receiving anti-platelet, anti-coagulant and", or thienopyridine medications, 2015, pp.42, 949~956
  51. Sawhney MS, "Risk factors for severe delayed postpolypectomy bleeding", Endoscopy, 40, pp.115~119 (2008)
  52. Bahin FF, "Prophylactic endoscopic coagulation to prevent bleeding after wide-field endoscopic mucosal resection of large sessile colon polyps", Clin Gastroenterol Hepatol, 13, pp.724~730 (2015)
  53. Burgess NG, "Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions", Clin Gastroenterol Hepatol, 12, pp.651~661 (2014)
  54. Metz AJ, "Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions", Endoscopy, 43, pp.506~511 (2011)
  55. Cao Y, "Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract", Endoscopy, 41, pp.751~757 (2009)
  56. Cho SJ, "Aspirin use and bleeding risk after endoscopic submucosal dissection in patients with gastric neoplasms", Endoscopy, 44, pp.114~121 (2012)
  57. Dong J, "Effects of antithrombotic therapy on bleeding after endoscopic submucosal dissection", Gastrointest Endosc, 86, pp.807~816 (2017)
  58. Koh R, "Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms", Gastrointest Endosc, 78, pp.476~483 (2013)
  59. Kono Y, "Postoperative bleeding risk after gastric endoscopic submucosal dissection during antithrombotic drug therapy", J Gastroenterol Hepatol, 33, pp.453~460 (2018)
  60. Libânio D, "Risk factors for bleeding after gastric endoscopic submucosal dissection : a systematic review and meta-analysis", Gastrointest Endosc, 84, pp.572~586 (2016)
  61. Lim JH, "Do antiplatelets increase the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms?", Gastrointest Endosc, 75, pp.719~727 (2012)
  62. Sanomura Y, "Continued use of low-dose aspirin does not increase the risk of bleeding during or after endoscopic submucosal dissection for early gastric cancer", Gastric Cancer, 17, pp.489~496 (2014)
  63. Arimoto J, "Continued use of a single antiplatelet agent does not increase the risk of delayed bleeding after colorectal endoscopic submucosal dissection", Dig Dis Sci, 63, pp.218~227 (2018)
  64. Ninomiya Y, "Risk of bleeding after endoscopic submucosal dissection for colorectal tumors in patients with continued use of low-dose aspirin", J Gastroenterol, 50, pp.1041~1046 (2015)
  65. Biondi-Zoccai GG, "A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50, 279 patients at risk for coronary artery disease", Eur Heart J, 27, pp.2667~2674 (2006)
  66. Maulaz AB, "Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke", Arch Neurol, 62, pp.1217~1220 (2005)
  67. Oscarsson A, "To continue or discontinue aspirin in the perioperative period : a randomized, controlled clinical trial", Br J Anaesth, 104, pp.305~312 (2010)
  68. Cotton PB, "Endoscopic sphincterotomy complications and their management : an attempt at consensus", Gastrointest Endosc, 37, pp.383~393 (1991)
  69. Freeman ML, "Complications of endoscopic biliary sphincterotomy", N Engl J Med, 335, pp.909~918 (1996)
  70. Hui CK, "Does withholding aspirin for one week reduce the risk of post-sphincterotomy bleeding?", Aliment Pharmacol Ther, 16, pp.929~936 (2002)
  71. Hussain N, "The safety of endoscopic sphincterotomy in patients receiving antiplatelet agents : a case-control study", Aliment Pharmacol Ther, 25, pp.579~584 (2007)
  72. Onal IK, "Do aspirin and non-steroidal anti-inflammatory drugs increase the risk of post-sphincterotomy hemorrhage--a case-control study", Clin Res Hepatol Gastroenterol, 37, pp.171~176 (2013)
  73. Nelson DB, "Major hemorrhage from endoscopic sphincterotomy : risk factor analysis", J Clin Gastroenterol, 19, pp.283~287 (1994)
  74. 황종호, "아스피린 복용 환자에서 내시경 유두 괄약근 절개술에 따른 출혈의 위험성", 대한내과학회지, 81(2), pp.193~198 (2011), 대한내과학회
  75. Feagins LA, "Low rate of postpolypectomy bleeding among patients who continue thienopyridine therapy during colonoscopy", Clin Gastroenterol Hepatol, 11, pp.1325~1332 (2013)
  76. Gandhi S, "Meta-analysis : colonoscopic post-polypectomy bleeding in patients on continued clopidogrel therapy", Aliment Pharmacol Ther, 37, pp.947~952 (2013)
  77. Singh M, "Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy", Gastrointest Endosc, 71, pp.998~1005 (2010)
  78. Lee MG, "Effect of sustained use of platelet aggregation inhibitors on post-endoscopic sphincterotomy bleeding", Dig Endosc, 26, pp.737~744 (2014)
  79. Sooyeon Oh, "Continuous Use of Thienopyridine May Be as Safe as Low-Dose Aspirin in Endoscopic Resection of Gastric Tum", Gut and Liver, 12(4), pp.393~401 (2018), 거트앤리버 소화기연관학회협의회
  80. Eisenberg MJ, "Safety of short-term discontinuation of antiplatelet therapy in patients with drug-eluting stents", Circulation, 119, pp.1634~1642 (2009)
  81. Hong SJ, "Effect of perioperative antiplatelet therapy on outcomes in patients with drug-eluting stents undergoing elective noncardiac surgery", Am J Cardiol, 123, pp.1414~1421 (2019)
  82. Choudari CP, "Acute gastrointestinal haemorrhage in anticoagulated patients : diagnoses and response to endoscopic treatment", Gut, 35, pp.464~466 (1994)
  83. Igarashi K, "Should antithrombotic therapy be stopped in patients undergoing gastric endoscopic submucosal dissection?", Surg Endosc, 31, pp.1746~1753 (2017)
  84. Witt DM, "Incidence and predictors of bleeding or thrombosis after polypectomy in patients receiving and not receiving anticoagulation therapy", J Thromb Haemost, 7, pp.1982~1989 (2009)
  85. White RH, "Temporary discontinuation of warfarin therapy : changes in the international normalized ratio", Ann Intern Med, 122, pp.40~42 (1995)
  86. Schulman S, "Clinical factors influencing normalization of prothrombin time after stopping warfarin : a retrospective cohort study", Thromb J, 6, pp.15~ (2008)
  87. Horiuchi A, "Removal of small colorectal polyps in anticoagulated patients : a prospective randomized comparison of cold snare and conventional polypectomy", Gastrointest Endosc, 79, pp.417~423 (2014)
  88. 정보영, "2018 Korean Guideline of Atrial Fibrillation Management", Korean Circulation Journal, 48(12), pp.1033~1080 (2018), 대한심장학회
  89. Douketis JD, "Perioperative bridging anticoagulation in patients with strial fibrillation", N Engl J Med, 373, pp.823~833 (2015)
  90. Friedland S, "Colonoscopic polypectomy in anticoagulated patients", World J Gastroenterol, 15, pp.1973~1976 (2009)
  91. Timothy SK, "Colonoscopy in the patient requiring anticoagulation", Dis Colon Rectum, 44, pp.1845~1848 (2001)
  92. Ara N, "Prospective analysis of risk for bleeding after endoscopic biopsy without cessation of antithrombotics in Japan", Dig Endosc, 27, pp.458~464 (2015)
  93. Kato M, "Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment : 2017appendix on anticoagulants including direct oral anticoagulants", Dig Endosc, 30, pp.433~440 (2018)
  94. Lee JH, "The 2018 Korean heart rhythm society practical guidelines on the use of non-vitamin K-antagonist oral anticoagulants : bleeding control and perioperative management", Korean J Med, 94, pp.40~56 (2019)
  95. Trocóniz IF, "Population pharmacokinetic analysis of the new oral thrombin inhibitor dabigatran etexilate(BIBR 1048)in patients undergoing primary elective total hip replacement surgery", J Clin Pharmacol, 47, pp.371~382 (2007)
  96. Heidbuchel H, "Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation : executive summary", Eur Heart J, 38, pp.2137~2149 (2017)
  97. Dunn A, "Perioperative management of oral anticoagulation : when and how to bridge", J Thromb Thrombolysis, 21, pp.85~89 (2006)

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