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Bleeding after endoscopic sphincterotomy or papillary balloon dilation among users of antithrombotic agents
Tsuyoshi Hamada1, Hideo Yasunaga2, Yousuke Nakai1
1Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Insights
Endoscopic procedures for bile duct stones are safe with antiplatelet agents. However, anticoagulants significantly increase severe bleeding risk, requiring further investigation for patient management.
Area of Science:
- Gastroenterology
- Hepatology
- Endoscopic Procedures
Background:
- Severe bleeding is a critical complication following endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) for choledocholithiasis.
- Evaluating the influence of antiplatelet agents and anticoagulants is crucial for patient safety.
Purpose of the Study:
- To assess the impact of antiplatelet agents and anticoagulants on severe bleeding after EST and EPBD.
- To determine the safety of continuing or discontinuing these medications during endoscopic procedures.
Main Methods:
- Analysis of a Japanese nationwide administrative database of 61,002 patients undergoing EST or EPBD.
- Statistical evaluation of the association between antiplatelet/anticoagulant use and severe bleeding within 3 days post-procedure, adjusting for risk factors.
Main Results:
- Antiplatelet agent use did not show a significant association with increased severe bleeding in either EST or EPBD groups.
- Anticoagulant use was significantly linked to a higher incidence of severe bleeding in both EST (OR 1.70) and EPBD (OR 2.91) procedures.
- EPBD was more common in patients with comorbidities or on antithrombotic therapy.
Conclusions:
- Endoscopic procedures like EST and EPBD appear safe for patients on antiplatelet agents.
- Anticoagulant use presents a high risk for severe bleeding, necessitating careful periprocedural management strategies.
Background And Study Aims:
Severe bleeding is a potentially lethal complication after endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) for choledocholithiasis. This study aimed to evaluate the impact of antiplatelet agents and anticoagulants on this complication.
Patients And Methods:
Patients who underwent EST and EPBD were identified in a Japanese nationwide administrative database covering 1090 hospitals. Adjusting for other potential risk factors, we evaluated the association between oral administration of antiplatelet agents and/or anticoagulants (continuation, discontinuation, and non-use) and clinically significant bleeding within 3 days of the procedure.
Results:
In total, 61 002 patients were analyzed (EST, 54 493 patients; EPBD, 6509). The rate of severe bleeding was 0.8 % in both groups, but EPBD was performed more frequently than EST in patients with chronic renal failure, liver cirrhosis, and in those receiving antiplatelet agents or anticoagulants. The impact of continuation/discontinuation of antiplatelet agents on severe bleeding was not statistically significant in the EST or EPBD groups. The use of anticoagulants was associated with a statistically significant increase in severe bleeding compared with non-use for EST (1.6 % 27 of 1688 patients vs. 0.8 % 429 of 52 805 patients; adjusted odds ratio [OR] 1.70; 95 % confidence interval [CI] 1.10 - 2.63) and for EPBD (3.0 % [8 of 263 patients] vs. 0.7 % 46 of 6246 patients; adjusted OR 2.91; 95 %CI 1.36 - 6.24).
Conclusions:
EST and EPBD can be safely performed in patients receiving antiplatelet agents. Users of anticoagulants are at high risk of bleeding, and the periprocedural management of these should be further investigated.
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