仙台赤十字病医誌 Vol.20, No.1, 25-32, 2011

原著

Management of Patients on Anticoaglant-AntiplateletTherapy Scheduled for Digestive Endoscopy:Developing Relationships with Prescribing Physiciansand Improving Informed Consent

Department of Gastroenterology, Japanese Red Cross Sendai Hospital

Shinya OOMORI, Toshihiro SATO and Atsushi KANNO

消化器内視鏡診療における抗凝固薬・抗血小板薬内服患者の管理:処方医との連携強化とinformed consentの充実を目指して

仙台赤十字病院 消化器内科

大森　信弥　　佐藤　俊裕　　菅野　　厚

Abstract

The approach to managing patients who receive anticoaglant-antiplatelet therapy and are scheduled to undergo endoscopic examination and therapy is one of the most important challenges in avoiding both postprocedural bleeding and thromboembolism. Here, we present our protocol for managing such patients. When planning endoscopic procedures for patients on these agents, we ask the prescribing physicians （primarily cardiologists or neurologists） their recommendations about interrupting therapy. We also establish our own protocol for suspending and resuming anticoaglant-antiplatelet therapy. Furthermore, after receiving permission for suspending these agents from the prescribing physician, we seek written informed consent from the patient for the discontinuation. In our department, documents have been prepared to facilitate these inquiries and requests for informed consent. Among the 979 cases in whom therapeutic endoscopies were performed, 92 cases （approximately 9.4%） had been prescribed anticoaglant-antiplatelet agents and were properly instructed to suspend the agents before the endoscopic procedure. Of the 92 cases who underwent endoscopic therapy, bleeding after colonic polypectomy was confirmed in seven cases, in whom endoscopic hemostasis was promptly achieved with hemoclips. In general, we resumed administration of anticoaglant-antiplatelet agents 2 days after endoscopic therapy, respectively. There was no occurrence of thromboembolism during the period in which the agents were discontinued. In performing endoscopic procedures for patients on anticoaglant-antiplatelet therapy, adequately planned preparation for the suspension and thorough explanation of the informed consent document to patients should lead to optimal medical care from the perspectives of both medical staff and patients.
要旨:当科における消化器内視鏡治療時の，抗凝固薬・抗血小板薬（ACAP薬）服用患者に対する対応を提示した。当科では，ACAP薬服用者に内視鏡治療を行う際には，事前に処方医に対して休薬の可否について問い合わせを行い，可であるとの返答を得たうえで，原則として当科におけるACAP薬休薬基準に従い，患者に対する休薬指導を行っている。休薬・再開に対しては，文書（同意書）を用いての確実なinformed consentを取得するように努めている。当院で施行した内視鏡治療979例中，92例がACAP薬内服状態であった。処方医の意見を参考にしつつ，治療前後に適宜ACAP薬を一定期間休薬したが，術後出血は，大腸ポリペクトミーの7例のみであり，全例速やかに内視鏡的に止血し得た。休薬期間における血栓塞栓症の合併は1例も認めなかった。ACAP薬の計画的な休薬と，適切にinformed consentを得ることで，医療側・患者側双方にとって納得のいく診療がなされ得るものと考えられた。

Key words:anticoaglant-antiplatelet therapy, endoscopic procedure, informed consent