Related Experiment Video
Updated: Aug 11, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Risk of post-sphincterotomy bleeding with antiplatelet and anticoagulant use: a propensity-matched analysis of the
Saurabh Chandan1, Aakash Desai2, Dushyant S Dahiya3
1Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, USA.
Insights
Patients on anticoagulant (AC) and antiplatelet (APT) therapy face increased gastrointestinal bleeding risk after endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy. Resuming AC within 24 hours post-procedure elevates this risk.
Area of Science:
- Gastroenterology
- Clinical Pharmacology
- Medical Device Technology
Background:
- Gastrointestinal (GI) bleeding is a significant risk following ERCP, particularly after sphincterotomy.
- Evidence for bleeding risk with anticoagulants (AC) and heparin is strong, but data for antiplatelet agents (APT) like clopidogrel and prasugrel is limited.
Purpose of the Study:
- To assess the risk of post-sphincterotomy GI bleeding in patients undergoing ERCP while on AC or APT therapy.
- To compare bleeding risks between AC and APT cohorts and identify associated factors.
Main Methods:
- Retrospective, propensity-matched cohort study using the U.S. TriNetX platform (data through December 27, 2022).
- Included patients receiving AC or APT therapy undergoing ERCP with sphincterotomy within 7 days of hospitalization.
- Primary outcome: GI bleeding within 7 days; secondary outcomes: transfusion, ICU care, mortality within 30 days.
Main Results:
- Both AC and APT cohorts showed increased post-sphincterotomy bleeding risk compared to controls (aOR 3.6 and 2.2, respectively).
- Heparin bridging and concurrent aspirin did not increase bleeding risk.
- Resuming AC within 24 hours post-procedure significantly increased GI bleeding risk.
Conclusions:
- Patients on AC or APT therapy have a heightened risk of GI bleeding after ERCP sphincterotomy.
- Consider drug cessation periods or alternative biliary decompression techniques for these high-risk patients.
Background And Aims:
GI bleeding after ERCP is a serious adverse event and most commonly occurs after endoscopic biliary and/or pancreatic sphincterotomy. Although the strength of available evidence for post-sphincterotomy GI bleeding risk is high for therapeutic warfarin and heparin, it remains unknown for antiplatelet agents like clopidogrel and prasugrel. We conducted a retrospective United States-based, propensity-matched cohort study to assess the risk of post-sphincterotomy bleeding in patients receiving anticoagulant (AC) and antiplatelet (APT) therapy.
Methods:
We analyzed the U.S. Collaborative Network in the TriNetX platform through December 27, 2022, to include patients receiving APT and AC therapy who underwent ERCP within 7 days of hospitalization. One-to-one propensity score matching was performed. The primary outcome was the incidence of GI bleeding within 7 days of sphincterotomy. Secondary outcomes included need for blood transfusion, intensive care unit care, and all-cause mortality within 30 days of bleeding.
Results:
Overall, 2806 patients (1806 in the AC cohort and 1000 in the APT cohort) underwent ERCP with sphincterotomy. One-to-one propensity score matching was performed for age, body mass index ≥30 kg/m2, gender, race, ethnicity, diabetes mellitus, nicotine dependence, presence and severity of chronic kidney disease, cirrhosis, and thrombocytopenia between the cohorts. Patients in both cohorts had an increased risk of post-sphincterotomy bleeding compared with matched control subjects (adjusted odds ratios of 3.6 [95% confidence interval, 2.58-5.06] and 2.2 [95% confidence interval, 1.43-3.56], respectively). Although heparin bridging therapy and concurrent use of aspirin did not further increase the risk of GI bleeding, resumption of AC within 24 hours' postprocedure did. Neither cohort of patients was at an increased risk for blood transfusion, intensive care unit care, or all-cause mortality.
Conclusions:
Our database analysis shows that patients receiving AC and APT therapy are at a higher risk of post-sphincterotomy bleeding compared with matched control subjects. An appropriate drug cessation period or alternative biliary decompression modalities may be used in these patients.
More Related Videos
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:22Aneurysm IV: Nursing Management
01:30Venous Thrombosis IV: Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:26Cardiac Catheterization IV: Nursing Management
01:29Venous Thrombosis III: Interprofessional Care