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Biliary-Pancreatic Endoscopic and Surgical Procedures in Patients under Dual Antiplatelet Therapy: A Single-Center
Ahmed Abdel Samie1, Michael Stumpf, Rui Sun
1Department of Gastroenterology, Pforzheim Hospital, Pforzheim, Germany.
Insights
Patients on dual antiplatelet therapy (aspirin/clopidogrel) can safely undergo emergency biliary-pancreatic surgery or endoscopy. This finding is crucial for managing patients needing urgent procedures while on these critical medications.
Area of Science:
- Gastroenterology
- Cardiology
- Surgical Oncology
Background:
- Dual antiplatelet therapy (DAPT) is standard after coronary stent placement.
- Guidelines recommend delaying elective surgery until DAPT completion due to bleeding risk.
- Limited data exists on bleeding risk in patients on DAPT undergoing urgent procedures.
Purpose of the Study:
- To evaluate the safety of emergency biliary-pancreatic surgery and endoscopic retrograde cholangiography with endoscopic sphincterotomy in patients on DAPT.
- To assess bleeding risk in this specific patient population.
Main Methods:
- Retrospective analysis of medical records.
- Inclusion of patients undergoing emergency biliary-pancreatic surgery or ERCP with ES between January 2009 and July 2012.
- Focus on patients on dual antiplatelet therapy (aspirin/clopidogrel).
Main Results:
- Eleven consecutive patients on DAPT underwent emergency procedures.
- No bleeding events were observed in any of the patients.
- Procedures included biliary-pancreatic surgery and endoscopic retrograde cholangiography with endoscopic sphincterotomy.
Conclusions:
- Emergency surgical and high-risk endoscopic procedures can be safely performed in patients on dual antiplatelet therapy.
- This suggests DAPT does not preclude necessary urgent interventions in selected cases.
Background/Aims:
Dual antiplatelet therapy has to be used for at least 1 month after placement of bare metal coronary stents and for a minimum of 1 year after placement of drug eluting stents. Because of the higher risk of bleeding, guidelines strongly recommend to delay elective surgery until dual antiplatelet therapy is ended. However, no data are available regarding the bleeding risk in patients on combined aspirin/clopidogrel therapy undergoing surgical or high-risk endoscopic procedures.
Methods:
We retrospectively analyzed the medical reports of patients on dual antiplatelet therapy, the patients who had to undergo emergency biliary-pancreatic surgery or endoscopic retrograde cholangiography with endoscopic sphincterotomy while in our unit between January 2009 and July 2012.
Results:
In our series, biliary-pancreatic surgical and endoscopic procedures were safely performed in 11 consecutive patients on dual antiplatelet therapy with no evidence of bleeding.
Conclusions:
In emergency, surgical and high risk endoscopic procedures may be performed in patients on dual antiplatelet therapy.
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