Heslinga, F. (Fimke) (2015) Veiligheid van het overbruggen van vitamine K antagonisten bij electieve gastro-intestinale endoscopische procedures. thesis, Medicine.
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Abstract
Background: If patients, treated with vitamin K antagonists (VKA) undergo surgery or an invasive procedure, interruption of the treatment with the VKA is often necessary. By stopping the VKA the thrombosis risk is increased while bleeding complications may occur when the use of anticoagulants continues. In gastrointestinal endoscopic procedures VKA are bridged with LMWH based on the CBO guideline: Diagnosis, Prevention and Treatment of Venous Thromboembolism and Secondary Prevention Arterial Thrombosis (2008). The present study aims to evaluate the safety of this guideline for these procedures. Patients and Methods: Data were collected from patients who use VKA and had a gastrointestinal endoscopic procedure with bridging therapy in the period: April 15th, 2009 to April 15th, 2014. The control group consisted of all patients who were not bridged, but only stopped the VKA before the procedure, in the same period. Periscopic hemorrhages were the primary endpoint of this study. Results: A total of 238 patients were (294 interventions) included in the bridge group and 138 patients (213 interventions) in the control group. In 12 procedures severe bleeding occurred after the endoscopy, of which 9 (3.1%) in the bridging group and 3 (1.4%) in the control group. There was no significant difference with regard to severe hemorrhages in both groups (p=0.38), nor after multivariate analysis (p=0,27). The total number of non-severe hemorrhages in the bridging group was 17 (5.8%) and in the control group 6 (2.8%). The incidence of severe and non-severe bleedings together was not significantly different in both groups (p=0.051), nor after multivariate analysis (p=0,070). One patient with an ischemic stroke in the bridge group was observed. No thromboembolic events occurred in the control group (p=1,00). Polypectomy was associated with hemorrhages. Polypectomy had an OR of 7.3 (95% CI 2.1-24.7) compared to patients who have had endoscopy only, with a p-value of 0,001. Univariate analysis showed that polypectomy was also a risk-factor for the occurrence of severe bleeding compared to patients who have had biopsy only (p=0,027), with an odds ratio of 5.7 (95% CI 1.2 to 26.3). Conclusion: The current bridge guideline appears to be safe in its present form. No significant difference is found in the incidence of severe bleeding between both groups. Also, no significant difference is found when all bleedings are taken together. However, a trend is shown, more bleedings occur in the bridged patients, especially non-severe bleedings. One thrombo-embolic event did occur in the bridge group and none in the control group. Polypectomy is a risk factor for the occurrence of severe and non-severe hemorrhages.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hoogendoorn, Dr. M. and Geven-Boere, Mw. Drs. L.M. and Kappelle, Dr. J.W. and Medisch Centrum Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:43 |
| Last Modified: | 25 Jun 2020 10:43 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/435 |
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