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Prospective analysis of risk for bleeding after endoscopic biopsy without cessation of antithrombotics in Japan
Nobuyuki Ara1, Katsunori Iijima1, Ryuhei Maejima1
1Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
Insights
Continuing antithrombotic therapy during upper gastrointestinal endoscopic biopsy is safe. This study found no increased bleeding risk for patients who did not stop their antithrombotic medication.
Area of Science:
- Gastroenterology
- Cardiology
- Internal Medicine
Background:
- Revised Japanese guidelines permit endoscopic biopsies while patients continue antithrombotic treatment.
- The bleeding risk associated with continuing antithrombotics during biopsy is not well-established due to the rarity of bleeding events.
Purpose of the Study:
- To prospectively evaluate the risk of bleeding after upper gastrointestinal endoscopic biopsy in patients continuing antithrombotic medication.
Main Methods:
- Prospective enrollment of patients undergoing upper gastrointestinal endoscopic biopsy (December 2011-March 2014).
- Assessment of antithrombotic medication status (continuation or cessation) at enrollment.
- Follow-up within 1 month post-biopsy via medical examination or telephone to identify bleeding events.
Main Results:
- Out of 3758 patients, 394 (10.5%) were on antithrombotics; 286 (72.6%) continued medication.
- Six bleeding events (0.15%) occurred post-biopsy; only one involved a patient continuing antithrombotics.
- No significant difference in bleeding incidence between patients continuing (0.35%) and discontinuing (0.14%) antithrombotics (P=0.38).
Conclusions:
- Continuation of antithrombotic therapy does not elevate the risk of bleeding after upper gastrointestinal endoscopic biopsy.
- The findings support current guidelines allowing biopsies without antithrombotic cessation in select patients.
Background And Aim:
In Japan, after the revision of the gastrointestinal endoscopic guidelines for patients taking antithrombotics, endoscopic biopsies were permitted while continuing antithrombotic treatment. However, the risk of bleeding after the biopsy with or without cessation of antithrombotics has not been fully evaluated because bleeding events are very rare. The aim of this prospective study was to evaluate the risk for bleeding after upper gastrointestinal biopsy without cessation of antithrombotics.
Methods:
Consecutive patients who underwent upper gastrointestinal endoscopic biopsy from December 2011 to March 2014 were enrolled in this study. Antithrombotic medication and its cessation status was checked at enrollment. To confirm bleeding events associated with biopsy, medical examination at the hospital or direct confirmation by telephone was done within 1 month after the biopsy.
Results:
Among the 3758 patients who underwent endoscopic biopsies, 394 patients (10.5%) were medicated with antithrombotics, and 286 of them (72.6% of the total antithrombotics users) did not undergo cessation. Bleeding after the biopsy occurred in six cases (0.15%, 95% CI; 0.09%∼0.22%), but there was only one case that had continued taking antithrombotics. The incidence of bleeding after biopsy was not significantly higher in the patients who had continued taking antithrombotics compared with the others (0.35% vs 0.14%, P = 0.38).
Conclusion:
This prospective study showed that continuation of antithrombotics did not increase the bleeding risk after upper gastrointestinal endoscopic biopsy.
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