La prise en charge des patients sous anticoagulants ou sous agents antiplaquettaires avant une endoscopie digestive

Acta Endoscopica - Tập 35 - Trang 351-363 - 2005
B. Napoléon1, B. Boneu2, L. Maillard3, Ch. M. Samama4, J. F. Schved2, G. Gay1, Th. Ponchon1, D. Sautereau1, J. M. Canard1
1Société Française d’Endoscopie Digestive, France
2Groupe d’Etude sur l’Hémostase et la Thrombose, France
3Groupe thrombose de la Société Française de Cardiologie, France
4Société Française d’Anesthésie Réanimation, France

Tóm tắt

La prise en charge de patients traités par antivitamine K (AVK) ou par agents antiplaquettaires (AAP) est un problème fréquent avant la réalisation d’une endoscopie digestive. Si le risque de saignement est une préoccupation légitime du gastroentérologue et de l’anesthésiste, le risque potentiel de l’arrêt du traitement antithrombotique ne doit pas être sous-estimé. Devant la multiplicité des situations, il est difficile d’édicter des règles permettant de tout prendre en compte et rares sont les guidelines pouvant servir de référentiels [1–3]. Idéalement, c’est en concertation avec le médecin prescripteur du traitement que les adaptations thérapeutiques devraient être envisagées en évaluant, au cas par cas, le rapport bénéfice/risque de la procédure et des modifications du traitement antithrombotique. Le plus souvent, cette situation idéale est difficile à mettre en œuvre : praticien prescripteur oublié par le patient ou non joignable, divergence d’opinion ou méconnaissance des risques respectifs de l’arrêt du traitement et du geste endoscopique, insuffisance de données de la littérature… En pratique, un certain nombre de données sont cependant disponibles pour choisir l’attitude à privilégier. Trois éléments sont à prendre en compte : le risque hémorragique de la procédure, le traitement antithrombotique utilisé, le risque thromboembolique à l’arrêt du traitement. Pour essayer d’aboutir à un consensus le plus large possible, la Société Française d’Endoscopie Digestive (SFED), le Groupe d’Etude sur l’Hémostase et la Thrombose (GEHT) de la Société Française d’Hématologie, la Société Française de Cardiologie (SFC) et la Société Française d’Anesthésie-Réanimation (SFAR) ont collaboré pour proposer ces recommandations. Elles restent évidemment indicatives et temporaires, susceptibles d’évoluer dans le temps et avec les connaissances scientifiques à venir. The management of patients treated with antivitamin K (AVK) or antiplatelet agents prior to digestive endoscopy is a frequent problem. If the risk of bleeding is a legitimate concern for gastroenterologists and anaesthesiologists, the potential risk of stopping antithrombotic therapy should not be underestimated. In front of the plethora of possible situations, it is difficult to formulate rules that account for everything and rare are the guidelines that can serve as reference frameworks [1–3].Ideally, adaptation of therapy should be considered in dialogue with the prescribing doctor by evaluating, individually, the risk/benefit ratio of the procedure and modification of antithrombotic treatment. Most often, it is difficult to reach this ideal situation: the prescribing doctor is forgotten by the patient or not available, there are differing opinions or insufficient understanding of the respective risks of stopping treatment and endoscopy, insufficient data in the literature… In practice, however, a certain amount of data is available to help choose which solution should be favoured. Three elements should be taken into consideration: the risk of haemorrhage of the procedure, the antithrombotic treatment used, and the thromboembolic risk upon stopping treatment. In an effort to reach the widest possible consensus, the Société Française d’ Endoscopie Digestive (SFED), the Groupe d’Etude sur l’Hémostase et la Thrombose (GEHT) of the Société Française d’ Hématologie, the Société Française de Cardiologie (SFC) and the Société Française d’Anesthésie-Réanimation (SFAR) collaborated to propose these recommendations. The recommendations remain indicative and temporary, and are likely to evolve over time with further scientific knowledge.

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Acta Endoscopica

Tập 35

351-363

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