Comparison of anticoagulants and risk factors for bleeding following endoscopic sphincterotomy among anticoagulant users: Results from a large multicenter retrospective study.
DOAC
delayed hemorrhage
endoscopic sphincterotomy
heparin replacement
warfarin
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
29
01
2019
revised:
09
06
2019
accepted:
11
06
2019
pubmed:
27
6
2019
medline:
4
9
2020
entrez:
26
6
2019
Statut:
ppublish
Résumé
Bleeding is an inevitable and often severe complication after endoscopic sphincterotomy (EST). We aimed to investigate the factors associated with post-EST bleeding in patients treated with anticoagulants. The data of patients who underwent EST at 15 hospitals between July 2015 and June 2017 were extracted. We investigated the incidence of post-EST bleeding and risk factors for bleeding in patients treated with anticoagulants. One hundred forty-nine patients undergoing EST who met the inclusion criteria were included in this study. The total-EST bleeding (bleeding occurring during or after EST) rate did not differ between the heparin replacement (8.0%, 6/75) and continuation (16.6%, 2/12; P = 0.37) groups of warfarin users. The total-EST-bleeding rate in the heparin replacement group (12.9%, 4/31) was significantly higher than that in the continuation group (0%, 0/31; P = 0.016) in direct oral anticoagulant (DOAC) users. The rate of total-EST bleeding with continuation of DOAC (0%, 0/31) was significantly lower with continuation of warfarin (16.6%, 2/12; P = 0.021). During-EST bleeding (bleeding occurring during EST) (P = 0.0083) and precut (P = 0.033) were significant risk factors for post-EST bleeding in all 149 patients. Heparin replacement was only a significant risk factor for total-EST bleeding (P = 0.033) in DOAC users. Heparin replacement was a significant risk factor for post-EST bleeding in DOAC users; however, there was no significant difference between the bleeding rate of heparin replacement and that of continuation groups in patients taking warfarin. During EST and precut were significant risk factors for post-EST bleeding in all patients treated with anticoagulants.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Bleeding is an inevitable and often severe complication after endoscopic sphincterotomy (EST). We aimed to investigate the factors associated with post-EST bleeding in patients treated with anticoagulants.
METHODS
METHODS
The data of patients who underwent EST at 15 hospitals between July 2015 and June 2017 were extracted. We investigated the incidence of post-EST bleeding and risk factors for bleeding in patients treated with anticoagulants.
RESULTS
RESULTS
One hundred forty-nine patients undergoing EST who met the inclusion criteria were included in this study. The total-EST bleeding (bleeding occurring during or after EST) rate did not differ between the heparin replacement (8.0%, 6/75) and continuation (16.6%, 2/12; P = 0.37) groups of warfarin users. The total-EST-bleeding rate in the heparin replacement group (12.9%, 4/31) was significantly higher than that in the continuation group (0%, 0/31; P = 0.016) in direct oral anticoagulant (DOAC) users. The rate of total-EST bleeding with continuation of DOAC (0%, 0/31) was significantly lower with continuation of warfarin (16.6%, 2/12; P = 0.021). During-EST bleeding (bleeding occurring during EST) (P = 0.0083) and precut (P = 0.033) were significant risk factors for post-EST bleeding in all 149 patients. Heparin replacement was only a significant risk factor for total-EST bleeding (P = 0.033) in DOAC users.
CONCLUSION
CONCLUSIONS
Heparin replacement was a significant risk factor for post-EST bleeding in DOAC users; however, there was no significant difference between the bleeding rate of heparin replacement and that of continuation groups in patients taking warfarin. During EST and precut were significant risk factors for post-EST bleeding in all patients treated with anticoagulants.
Substances chimiques
Anticoagulants
0
Warfarin
5Q7ZVV76EI
Heparin
9005-49-6
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
37-42Informations de copyright
© 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Vaira D, D'Anna L, Ainley C et al. Endoscopic sphincterotomy in 1000 consecutive patients. Lancet 1989; 2: 431-434.
Freeman ML, Nelson DB, Sherman S et al. Complications of endoscopic biliary sphincterotomy. NEJM 1996; 335: 909-918.
Nelson DB, Freeman ML. Major hemorrhage from endoscopic sphincterotomy: risk factor analysis. J. Clin. Gastroenterol. 1994; 19: 283-287.
Lambert ME, Betts CD, Hill J et al. Endoscopic sphincterotomy: the whole truth. Br. J. Surg. 1991; 78: 473-476.
Bergman JJ, Rauws EA, Fockens P et al. Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bile duct stones. Lancet 1997; 349: 1124-1129.
Fujita N, Maguchi H, Komatsu Y et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: a prospective randomized controlled multicenter trial. Gastrointest. Endosc. 2003; 57: 151-155.
Baigent C, Blackwell L et al. Antithrombotic trialists' collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373: 1849-1860.
Diener HC, Cunha L, Forbes C et al. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J. Neurol. Sci. Turk. 1996; 143: 1-13.
Kwok A, Faigel DO. Management of anticoagulation before and after gastrointestinal endoscopy. Am. J. Gastroenterol. 2009; 104: 3085-3097.
Hamada T, Yasunaga H, Nakai Y et al. Bleeding after endoscopic sphincterotomy or papillary balloon dilation among users of antithrombotic agents. Endoscopy 2015; 47: 997-1004.
Nagata N, Yasunaga H, Matsui H et al. Therapeutic endoscopy-related GI bleeding and thromboembolic events in patients using warfarin or direct oral anticoagulants: results from a large nationwide database analysis. Gut 2017; 0: 1-8.
Ikarashi S, Katanuma A, Kin T et al. Factors associated with delayed hemorrhage after endoscopic sphincterotomy: Japanese large single-center experience. J. Gastroenterol. 2017; 52: 1258-1265.
Li HK, Chen FC, Rea RF et al. No increased bleeding events with continuation of oral anticoagulation therapy for patients undergoing cardiac device procedure. Pacing Clin. Electrophysiol. 2011; 34: 868-874.
Di Biase L, Burkhardt JD, Santangeli P et al. Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the role of Coumadin in preventing thromboembolism in atrial fibrillation (AF) patients undergoing catheter ablation (COMPARE) randomized trial. Circulation 2014; 129: 2638-2644.
Fujimoto K, Fujishiro M, Kato M et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig. Endosc. 2014; 26: 1-14.
Cotton P, Lehman G, Vennes J et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest. Endosc. 1991; 37: 383-393.
Kim HJ, Kim MH, Kim DI et al. Endoscopic hemostasis in sphincterotomy-induced hemorrhage: its efficacy and safety. Endoscopy 1999; 31: 431-436.
Hori Y, Naitoh I, Nakazawa T et al. Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients. J. Gastroenterol. Hepatol. 2014; 29: 648-652.
Nakaji S, Hirata N, Matsui H et al. Hemodialysis is a strong risk factor for post-endoscopic sphincterotomy bleeding in patients with choledocholithiasis. Endosc. Int. Open 2018; 6: E568-E574.
Shingina A, Barkun AN, Razzaghi A et al. Systematic review: the presenting international normalised ratio (INR) as a predictor of outcome in patients with upper nonvariceal gastrointestinal bleeding. Aliment. Pharmacol. Ther. 2011; 33: 1010-1018.
Chan FKL, Goh KL, Reddy N et al. Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines. Gut 2018; 67: 405-417.
Acosta RD, Abraham NS, Chandrasekhara V et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest. Endosc. 2016; 83: 3-16.
Abdel Samie A, Dette S, Voehringer U, Sun R, Theilmann L. Endoscopic biliary sphincterotomy in patients under antithromboembolic therapy. Z. Gastroenterol. 2017; 55: 841-847.