EndoTODAY | EndoATLAS | OPD

Parasite | Eso | Sto | Cancer | ESD

Boxim | DEX | Sono | Schedule

Home | Recent | Blog | Links

EndoTODAY ³»½Ã°æ ±³½Ç


[UlcerTODAY 012. ¿ÍÆĸ° »ç¿ë ȯÀÚÀÇ ÃâÇ÷]

Previous | Next

[2017-9-12. ¾Öµ¶ÀÚ Áú¹®]

¼øȯ±â³ª ½Å°æ°ú ¹®Á¦·Î ¿ÍÆĸ°À» º¹¿ëÇϴ ȯÀÚÁß¿¡ ±Þ¼ºÀ¸·Î À§Àå°ü ÃâÇ÷ÀÌ ÀÖ¾î ÀÔ¿øÇÏ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ÀÌ·² ¶§ INR 6ÀÌ°í hematemesis°¡ ÀÖ¾î ÀÀ±Þ³»½Ã°æÀ» ÇØ¾ß Çϴµ¥, Clip À̳ª ´Ù¸¥ ÁöÇ÷Á¦ Áֻ縦 ÇÏ´Â °Í¸¸À¸·Îµµ INRÀÌ ³ô±â ¶§¹®¿¡ »õ·Î¿î ÃâÇ÷À» ÀÏÀ¸Å³¼ö ÀÖÀ» °¡´É¼ºÀÌ ÀÖ¾î ¿°·Á°¡ µË´Ï´Ù.

1) ÀÌ·¸°Ô INRÀÌ ³ôÀº ȯÀÚ¿¡¼­ ±Þ¼º ÃâÇ÷ÀÌ ÀÖ¾î ÀÀ±Þ ³»½Ã°æÀ» ÇÒ ¶§ vitamin K, FFP¸¦ ¸ðµÎ ÁÖ°í ÀÀ±Þ ³»½Ã°æÀ» ÇϽôÂÁö¿ä? ¾Æ´Ï¸é INR¼öÄ¡¿¡ µû¶ó vitamin K ¸¸ ÁÖ»çÇϽôÂÁö¿ä?

2) INRÀÌ ³ô´õ¶óµµ ±Þ¼º ÃâÇ÷À̸é ÀÀ±Þ ³»½Ã°æ ÁöÇ÷¼úÀ» À§ÇØClip À̳ª ´Ù¸¥ ÁöÇ÷Á¦ Áֻ縦 ÇؾßÇÏ´Â °ÍÀÎÁö¿ä? ¾Æ´Ï¸é vitamin K, FFP¸¦ ÁÖ°í INRÀÌ º¸Åë ¾ó¸¶ ÀÌÇÏ°¡ µÉ ¶§ ÀÀ±Þ ³»½Ã°æ ÁöÇ÷¼úÀ» ÇÏ´Â °ÍÀÌ ÁÁÀ»Áö¿ä?

[2017-9-13. ¹Î¾ç¿ø ±³¼ö´Ô ´äº¯]

Active GI bleeding ȯÀÚ¿¡¼­´Â ³»½Ã°æ Àü warfarin Áß´Ü°ú ÇÔ²² INR ±³Á¤ÀÌ ÇÊ¿äÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù. ½ÇÁ¦ ESGE guideline (Endoscopy 2015) ¿¡¼­µµ ÃâÇ÷½Ã PT INR 2.5 ¹Ì¸¸À¸·Î ³»½Ã°æ Àü ±³Á¤Ç϶ó°í µÇ¾î ÀÖ½À´Ï´Ù. ±³Á¤ÇÏ´Â ¹æ¹ýÀº FFP ¶Ç´Â Vit K ¶Ç´Â µÑÀ» ÇÔ²² ÁÙ ¼ö ÀÖÀ» ÅÙµ¥ ȯÀÚ »óÅ µî¿¡ µû¶ó °áÁ¤ÇØ¾ß ÇÏ°Ú½À´Ï´Ù.

¸¸¾à INR 6 ÀÌ°í hematemesis ¸¦ ÇÑ´Ù¸é ºü¸¥ ±³Á¤ÀÌ ÇÊ¿äÇÒ Å×´Ï FFP (+ Vit K) ¸¦ ÁÝ´Ï´Ù. ¹®Á¦´Â INR ÀÌ ÃæºÐÈ÷ ±³Á¤µÉ ¶§±îÁö ±â´Ù·Á¾ß ÇÏ´Â °Çµ¥, ȯÀÚ »óÅÂ¿Í ³»½Ã°æ ÀÇ»çÀÇ °æÇè¿¡ µû·Á °áÁ¤µÉ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. ¸¸¾à Àú¶ó¸é active bleeding »óȲ¿¡¼­´Â °æÇèÀû ¼öÇ÷À» ÇÏ°í (FFP 1-3 pack) ¿ì¼± ³»½Ã°æÀ» ½ÃÇàÇØ º¼ °Í °°½À´Ï´Ù. ÃâÇ÷ º´¼ÒÀÇ ¼º°Ý¿¡ µû¶ó ´çÀå ³»½Ã°æÀû ÁöÇ÷¼úÀÌ ÇÊ¿äÇÒ ¼öµµ ÀÖ°í INR ±³Á¤¸¸À¸·Îµµ ÁÁ¾ÆÁú ¼ö Àֱ⠶§¹®¿¡ Ãß°¡ Ä¡·á ¹æħÀ» »¡¸® Á¤ÇÒ ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù. ³»½Ã°æ Ä¡·á¹ýÀÇ Á¾·ù´Â INR ÀÌ ¾î´ÀÁ¤µµ ±³Á¤µÇ¾ú´Ù°í »ý°¢µÇ¸é Å©°Ô ¿µÇâ¹ÞÁö ¾ÊÀ» °Í °°¾Æ º´¼ÒÀÇ ¼º°Ý°ú ³»½Ã°æ ÀÇ»çÀÇ ±â¼ú¿¡ µû¶ó Á¤ÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.

±¸Ã¼ÀûÀÎ ´äº¯Àº ¸ø µÇ¾úÁö¸¸ ¾î´ÀÁ¤µµ °³ÀÎÀûÀÎ ÀÇ°ßÀÇ ´À³¦ÀÌ Àü´ÞµÇ¾úÀ¸¸é ÁÁ°Ú½À´Ï´Ù. °¨»çÇÕ´Ï´Ù.

[2017-9-21. ÀÌÁØÇà]

»ï¼º¼­¿ïº´¿ø ÀÌÇõ ±³¼ö´Ô²²¼­ ¿ÍÆĸ° »ç¿ë ȯÀÚÀÇ ³»½Ã°æ ÁöÇ÷¼ú °ü·Ã ºÐ¼®À» ÇÑ ÀûÀÌ Àִٸ鼭 °ü·Ã ³í¹®À» ¾Ë·ÁÁּ̽À´Ï´Ù (Shim CN. Am J Ther 2016). ÀÌÇõ ±³¼ö´Ô²²¼­ ¿¬¼¼´ëÇб³ ÀçÁ÷ ÁßÀÏ ¶§ ¿¬¼¼´ëÇб³ ½ÅÃÌ ¼¼ºê¶õ½º º´¿ø ÀڷḦ ºÐ¼®ÇÑ °á°ú¿´½À´Ï´Ù.

Is Endoscopic Therapy Safe for Upper Gastrointestinal Bleeding in Anticoagulated Patients With Supratherapeutic International Normalized Ratios?
The management of upper gastrointestinal bleeding (UGIB) in anticoagulated patients with supratherapeutic international normalized ratios (INRs) presents a challenge. The purpose of the study was to evaluate the safety of endoscopic therapy for UGIB in anticoagulated patients with supratherapeutic INR in terms of rebleeding and therapeutic outcomes. One hundred ninety-two anticoagulated patients who underwent endoscopic treatment for UGIB were enrolled in the study. Patients were divided into 2 groups based on the occurrence of rebleeding within 30 days of the initial therapeutic endoscopy: no-rebleeding group (n = 168) and rebleeding group (n = 24). The overall rebleeding rate was 12.5%. Bleeding from gastric cancer and bleeding at the duodenum were significantly related to rebleeding in a univariate analysis. Multivariate analysis determined that presenting symptoms other than melena (hematemesis, hematochezia, or others) (odds ratio, 3.93; 95% confidence interval, 1.44-10.76) and bleeding from gastric cancer (odds ratio, 6.10; 95% confidence interval, 1.27-29.25) were significant factors predictive of rebleeding. Supratherapeutic INR at the time of endoscopic therapy was not significantly associated with rebleeding in either univariate or multivariate analysis. Significant differences in bleeding-related mortality, additional intervention to control bleeding, length of hospital stay, and transfusion requirements were revealed between the rebleeding and no-rebleeding groups. There were no significant differences in therapeutic outcomes between patients with INR within the therapeutic range and those with supratherapeutic INR. Supratherapeutic INR at the time of endoscopic therapy did not change rebleeding and therapeutic outcomes. Thus, we should consider endoscopic therapy for UGIB in anticoagulated patients, irrespective of INR at the time of endoscopic therapy.

¿ÍÆĸ° »ç¿ë ȯÀÚ°¡ ÃâÇ÷À» ÇÏ¿´À» ¶§ ¾î¶°ÇÑ °æ°ú¸¦ º¸ÀÌ´ÂÁö Àß º¸¿©ÁÖ´Â ÀÚ·á(ÀçÃâÇ÷·ü°ú »ç¸Á·ü µî)¶ó°í ÆǴܵǾú½À´Ï´Ù.

ÁÁÀº ÀÚ·á ¾Ë·ÁÁֽŠÀÌÇõ ±³¼ö´Ô²² °¨»çµå¸³´Ï´Ù.


[References]

1) UlcerTODAY - ¼ÒÈ­¼º ±Ë¾ç Áõ·Ê ÅäÀÇ

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (2017-9-11)