Delayed bleeding after endoscopic sphincterotomy in patients receiving anticoagulants

Area of Science:

• Gastroenterology
• Pharmacology
• Cardiology

Background:

• Delayed bleeding post-endoscopic sphincterotomy (EST) affects 0.5-5% of patients.
• Increasing use of anticoagulants (DOACs, warfarin) for cardiovascular disease elevates post-EST bleeding risk.
• Current guidelines may not fully mitigate bleeding risk in antithrombotic drug users.

Purpose of the Study:

• To review risk factors, guidelines, and pharmacological aspects of post-EST bleeding in anticoagulant users.
• To explore methods for monitoring anticoagulant effects and identifying high-risk patients.
• To discuss future directions for preventing post-EST bleeding.

Main Methods:

• Literature review focusing on post-EST bleeding in patients using anticoagulants.
• Analysis of risk factors, clinical guidelines, and pharmacological properties of anticoagulants.
• Investigation of novel monitoring parameters for anticoagulant effects.

Main Results:

• Anticoagulant use significantly increases post-EST bleeding risk, even with guideline adherence.
• Accurate monitoring parameters for direct oral anticoagulants (DOACs) are lacking.
• Plasma levels and antifactor Xa activity show promise for monitoring factor Xa inhibitors, similar to warfarin's PT-INR.

Conclusions:

• Identifying patients at high risk for post-EST bleeding is crucial.
• Plasma levels and antifactor Xa activity may help monitor DOACs and identify at-risk individuals.
• Future research should focus on developing risk-stratification scoring systems for post-EST delayed bleeding.