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Association between Antithrombotic Drug Management and Bleeding during High-Risk Endoscopic Procedures: A Multicenter
Makoto Imai1, Tomonori Aoki2, Ryota Niikura3,4
1Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Digestion
|May 19, 2026
Summary
Managing antithrombotic drugs (ATDs) during high-risk endoscopy impacts bleeding risk. This study found varied bleeding patterns based on ATD management strategies, informing safer patient care.
Area of Science:
- Gastroenterology
- Cardiology
- Endoscopic Surgery
Background:
- Optimal antithrombotic drug (ATD) management is crucial for minimizing bleeding during high-risk endoscopic procedures.
- Peri-procedural ATD strategies require careful consideration to balance thrombosis prevention and bleeding risk.
Purpose of the Study:
- To investigate peri-procedural ATD management strategies.
- To reduce 30-day post-procedural bleeding in patients undergoing high-risk endoscopic procedures.
Main Methods:
- Multicenter, retrospective cohort study.
- Inclusion of high-risk upper and lower gastrointestinal endoscopic procedures.
- Categorization of ATD management into continuation, discontinuation, and replacement, compared to nonusers.
Main Results:
- 30-day bleeding rates were 5.89% for upper-GI and 1.22% for lower-GI procedures.
- Differential bleeding risk patterns observed based on ATD management.
- Numerically higher bleeding rates in some upper-GI ATD management groups (e.g., aspirin continuation, thienopyridine discontinuation during gastric ESD), with absolute risk differences within 10%.
Conclusions:
- This study highlights differential bleeding risk patterns associated with various antithrombotic drug management strategies.
- Findings provide insights into optimizing ATD use during high-risk endoscopic interventions.
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