Risk of bleeding following double balloon enteroscopy in patients on continued antiplatelet and/or anticoagulation...

Area of Science:

• Gastroenterology
• Endoscopy
• Pharmacology

Background:

• Gastrointestinal bleeding risk associated with anticoagulation (AC) and antiplatelet (AP) therapy post-double balloon enteroscopy (DBE) is not well-established.
• Limited data exist on the incidence and characteristics of bleeding in patients undergoing DBE while on AC or AP therapy.

Purpose of the Study:

• To evaluate the incidence and clinical features of gastrointestinal bleeding after DBE in patients on AC and AP therapy.
• To determine if continued AP therapy is an independent risk factor for post-DBE bleeding.

Main Methods:

• Retrospective review of 683 patients undergoing DBE between 2009-2013 at Mayo Clinic, Florida.
• Patients categorized into three groups: continued AP, AC therapy, or neither.
• Follow-up data collected at 60 days and 1 year to assess bleeding events.

Main Results:

• No significant difference in post-DBE bleeding rates between AP and non-AP groups at 60 days (11.5% vs 7.5%) or 1 year (19.9% vs 15.7%).
• Patients on AC therapy experienced bleeding rates of 11.6% within 60 days and 22.5% within 1 year.
• Multivariate analysis identified American Society of Anesthesiologist >3 and GI bleeding indication as independent risk factors for post-DBE bleeding within 1 year.

Conclusions:

• Continued antiplatelet therapy at the time of DBE is not an independent risk factor for post-procedure bleeding.
• Anticoagulation therapy may be associated with increased bleeding risk post-DBE.
• American Society of Anesthesiologist score and indication for DBE are significant risk factors for post-DBE bleeding.