Safety and effectiveness of peroral endoscopic myotomy in patients on antiplatelet or anticoagulant therapy: an international multicenter case-control study.

Anticoagulants / therapeutic use Case-Control Studies Esophageal Achalasia Humans Myotomy Natural Orifice Endoscopic Surgery Treatment Outcome

Journal

Gastrointestinal endoscopy

ISSN: 1097-6779

Titre abrégé: Gastrointest Endosc

Pays: United States

ID NLM: 0010505

Informations de publication

Date de publication:
04 2021

Historique:

received: 30 05 2020

accepted: 14 07 2020

pubmed: 28 7 2020

medline: 1 6 2021

entrez: 28 7 2020

Statut: ppublish

Résumé

The risk of bleeding and thromboembolic events in patients undergoing peroral endoscopic myotomy (POEM) who are receiving antithrombotic therapy is unknown. Our primary aim was to assess the safety of POEM in this patient subset. Secondary outcomes were rates of clinical success, GERD, and procedure-related outcomes. This was an international, 1:1, case-control study performed at 10 centers using prospectively maintained databases. All consecutive patients who underwent POEM before November 2019 were considered for inclusion. Cases were patients on antiplatelet and/or anticoagulant therapy. Controls not receiving antithrombotics were matched for age and esophageal motility disorder. Primary outcomes were major bleeding and thromboembolic events on postprocedural day 30. Of 2895 patients who underwent POEM, 126 cases (103 on antiplatelets, 35 anticoagulants, 12 both) and 126 controls were enrolled. The rate of major bleeding was higher for the antithrombotics users (5.6% vs 0.8%, P = .03). Anticoagulants and clopidogrel were temporarily interrupted in all cases. Aspirin was continued in 40.5% of users without increasing the bleeding risk. One thromboembolic event occurred in each group (0.79%; P = 1.00). No POEM-related deaths were noted. Rates of clinical success (91.7% vs 96% in controls, P = .20), postprocedural GERD, and technical-related outcomes were similar in both groups. Antithrombotic management was heterogeneous, and guidelines were not adhered to in 23.8% of cases. POEM is safe and effective in patients receiving antithrombotic therapy although it is associated with a greater risk of major bleeding.

Sections du résumé

BACKGROUND AND AIMS

METHODS

This was an international, 1:1, case-control study performed at 10 centers using prospectively maintained databases. All consecutive patients who underwent POEM before November 2019 were considered for inclusion. Cases were patients on antiplatelet and/or anticoagulant therapy. Controls not receiving antithrombotics were matched for age and esophageal motility disorder. Primary outcomes were major bleeding and thromboembolic events on postprocedural day 30.

RESULTS

Of 2895 patients who underwent POEM, 126 cases (103 on antiplatelets, 35 anticoagulants, 12 both) and 126 controls were enrolled. The rate of major bleeding was higher for the antithrombotics users (5.6% vs 0.8%, P = .03). Anticoagulants and clopidogrel were temporarily interrupted in all cases. Aspirin was continued in 40.5% of users without increasing the bleeding risk. One thromboembolic event occurred in each group (0.79%; P = 1.00). No POEM-related deaths were noted. Rates of clinical success (91.7% vs 96% in controls, P = .20), postprocedural GERD, and technical-related outcomes were similar in both groups. Antithrombotic management was heterogeneous, and guidelines were not adhered to in 23.8% of cases.

CONCLUSIONS

POEM is safe and effective in patients receiving antithrombotic therapy although it is associated with a greater risk of major bleeding.

Identifiants

DOI: 10.1016/j.gie.2020.07.030 PMID: 32717366

pubmed: 32717366

pii: S0016-5107(20)34581-8

doi: 10.1016/j.gie.2020.07.030

pii:

doi:

Substances chimiques

Anticoagulants 0

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

839-849

Commentaires et corrections

Type : CommentIn