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ȣ - 540038 4 |
| Do all the patients taking antiplatelet agents undergoing routine gastroscopic mucosal biopsy should stop these agents one week before ? :Implications from gastric mucosal bleeding time and antiplatelets discontinuation study(BLISS study) |
| 한림의대 강남성심병원 심장내과¹ , 한림의대 강남성심병원 소화기내과² |
| 유하나¹, 안병무¹ , 이경민¹ , 조정래¹ , 김진배² , 최성훈¹ , 신수린² , 김효정² , 박상훈² , 이남호¹ , 이명석² |
Background: According to the ACC/AHA guidelines, the patients undergoing invasive procedures should stop antiplatelet agents for 5 – 7 days. But, it is often difficult to follow this rule due to thrombosis concern. In this study, we sought to evaluate the usefulness of gastric mucosal bleeding time(BT) in patients taking antiplatelet agents at the time of gastroscopic mucosal biopsy(GMB) and to investigate the optimal time interval between antiplatelet discontinuation and the endoscopic procedures.
Methods: In this prospective observational study, 25 patients having chest pain(CP) and 6 healthy subjects(HS) were enrolled(54.5±15.3 years, M:F 16:15). Among them, 4 patients had previous coronary stenting due to chronic stable angina and 2 patient took aspirin 100mg and clopidogrel 75mg, whereas the other 2 patients took aspirin 100mg only. The remaining 24 patients underwent coronary angiogram(CAG) which revealed no significant coronary stenoses. All the patients with CP group began taking aspirin 100mg and clopidogrel 75mg 3 days before CAG. The whole study subjects underwent GMB at the gastric angle and observed for BT. In CP groups, antiplatelets agents were discontinued before GMB for 0-3 days at the physicians discretion. BT was defined as the time of complete hemostasis with close observation at the biopsy site with cold saline flush for every 30 seconds(s).
Results: All the patients showed complete hemostasis at the GMB site without complications: The BT for CP group ranged from 120 to 420s(mean 229.2±94.5s), which showed no difference with HS group(210.0±26.8s, p=0.39). The BT after the day of antiplatelet discontinuation showed trends towards decrease without statistical significance(0day: 264.0±57.7s, 1day: 224.6±99.4, 2days: 180.0±84.9 and 3days: 150.0±42.4 respectively; p=NS). The number of antiplatelet agent used did not affect the difference in BT(1 agents: 200.0±79.8, 2 agents: 222.2±91.7s, p=0.60).
Conclusion: BT can be a useful marker of mucosal bleeding after gastroscopic biopsy. From this study, we could speculate that 1 day antiplatelet discontinuation is enough to minimize bleeding risk in these patients undergoing GMB.
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