Periprocedural Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant Undergoing a Digestive Endoscopy.
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
01 05 2023
01 05 2023
Historique:
received:
23
03
2022
accepted:
06
10
2022
medline:
4
5
2023
pubmed:
27
11
2022
entrez:
26
11
2022
Statut:
ppublish
Résumé
The periprocedural management of patients with atrial fibrillation (AF) using a direct oral anticoagulant (DOAC) undergoing elective gastrointestinal (GI) endoscopic procedure remains uncertain. We investigated the safety of a standardized periprocedural DOAC management strategy. The Periprocedural Anticoagulation Use for Surgery Evaluation cohort study enrolled adult patients receiving a DOAC (apixaban, rivaroxaban, or dabigatran) for AF scheduled for an elective procedure or surgery. This analysis addresses patients undergoing digestive endoscopy. Standardized periprocedural management consisted of DOAC interruption 1 day preendoscopy with resumption 1 day after procedure at low-moderate risk of bleeding or 2 days in case of a high bleeding risk. Thirty-day outcomes included GI bleeding, thromboembolic events, and mortality. Of 556 patients on a DOAC (mean [SD] age of 72.5 [8.6] years; 37.4% female; mean CHADS 2 score 1.7 [1.0]), 8.6% were also on American Society of Anesthesiology (ASA) and 0.7% on clopidogrel. Most of the patients underwent colonoscopies (63.3%) or gastroscopies (14.0%), with 18.9% having both on the same procedural day. The mean total duration of DOAC interruption was 3.9 ± 1.6 days. Four patients experienced an arterial thromboembolic event (0.7%, 0.3%-1.8%) within 24.2 ± 5.9 days of DOAC interruption. GI bleeding events occurred in 2.5% (1.4%-4.2%) within 11.1 ± 8.1 days (range: 0.6; 25.5 days) of endoscopy, with major GI bleeding in 0.9% (0.4%-2.1%). Three patients died (0.5%; 0.2%-1.6%) 15.6-22.3 days after the endoscopy. After a contemporary standardized periprocedural management strategy, patients with AF undergoing DOAC therapy interruption for elective digestive endoscopy experienced low rates of arterial thromboembolism and major bleeding.
Identifiants
pubmed: 36434811
doi: 10.14309/ajg.0000000000002076
pii: 00000434-202305000-00017
doi:
Substances chimiques
Anticoagulants
0
Rivaroxaban
9NDF7JZ4M3
Dabigatran
I0VM4M70GC
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
812-819Informations de copyright
Copyright © 2022 by The American College of Gastroenterology.
Références
Healey JS, Eikelboom J, Douketis J, et al. Periprocedural bleeding and thromboembolic events with dabigatran compared with warfarin: Results from the randomized evaluation of long-term anticoagulation therapy (RE-LY) randomized trial. Circulation 2012;126:343–8.
Abraham NS, Noseworthy PA, Inselman J, et al. Risk of gastrointestinal bleeding increases with combinations of antithrombotic agents and patient Age. Clin Gastroenterol Hepatol 2020;18:337–46.e19.
Abraham NS, Noseworthy PA, Yao X, et al. Gastrointestinal safety of direct oral anticoagulants: A large population-based study. Gastroenterology 2017;152:1014–22.e1.
Rodríguez de Santiago E, Sánchez Aldehuelo R, Riu Pons F, et al. Endoscopy-related bleeding and thromboembolic events in patients on direct oral anticoagulants or vitamin K antagonists. Clin Gastroenterol Hepatol 2021;20:e380–97.
Acosta RD, Abraham NS, Chandrasekhara V, et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc 2016;83:3–16.
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;67:405–17.
Veitch AM, Radaelli F, Alikhan R, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut 2021;70:1611–28.
Douketis JD, Spyropoulos AC, Duncan J, et al. Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant. JAMA Intern Med 2019;179:1469–78.
Siegal D, Yudin J, Kaatz S, et al. Periprocedural heparin bridging in patients receiving vitamin K antagonists: Systematic review and meta-analysis of bleeding and thromboembolic rates. Circulation 2012;126:1630–9.
Schulman S, Carrier M, Lee AY, et al. Perioperative management of dabigatran: A prospective cohort study. Circulation 2015;132:167–73.
Douketis JD, Spyropoulos AC, Anderson JM, et al. The perioperative anticoagulant use for surgery evaluation (PAUSE) study for patients on a direct oral anticoagulant who need an elective surgery or procedure: Design and rationale. Thromb Haemost 2017;117:2415–24.
Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration. Epidemiology 2007;18:805–35.
Spyropoulos AC, Al-Badri A, Sherwood MW, et al. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost 2016;14:875–85.
Doherty JU, Gluckman TJ, Hucker WJ, et al. ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: A report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol 2017;69:871–98.
Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice guidelines. Chest 2012;141:e326S–50S.
Schulman S, Angeras U, Bergqvist D, et al. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost 2010;8:202–4.
Spyropoulos AC, Douketis JD, Gerotziafas G, et al. Periprocedural antithrombotic and bridging therapy: Recommendations for standardized reporting in patients with arterial indications for chronic oral anticoagulant therapy. J Thromb Haemost 2012;10:692–4.
Taghiakbari M, Pohl H, Djinbachian R, et al. What size cutoff level should be used to implement optical polyp diagnosis? Endoscopy 2022. doi: 10.1055/a-1843-9535. Online ahead of print.
Chapelle N, Martel M, Bardou M, et al. Role of the endoscopic Doppler probe in nonvariceal upper gastrointestinal bleeding: Systematic review and meta-analysis. Dig Endosc 2022. doi: 10.1111/den.14356. Online ahead of print.
Jiang W, Suen BY, Ho HT, et al. Impact of physicians' and patients' compliance on outcomes of colonoscopic polypectomy with anti-thrombotic therapy. Clin Gastroenterol Hepatol 2021;19:2559–66.e1.
Douketis JD, Hasselblad V, Ortel TL. Bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 2016;374:93–4.
Barkun AN, Laine L, Leontiadis GI, et al. Over-the-scope clips versus standard treatment. Gut 2022; gutjnl-2022-327712. doi: 10.1136/gutjnl-2022-327712. Online ahead of print.
Spadaccini M, Albeniz E, Pohl H, et al. Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: Meta-analysis of randomized trials. Gastroenterology 2020;159:148–58.e11.
Abraham NS, Barkun AN, Sauer BG, et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice guideline: Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. Am J Gastroenterol 2022;117:542–58.
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 2018;67:1805–12.
Radaelli F, Fuccio L, Paggi S, et al. Periendoscopic management of direct oral anticoagulants: A prospective cohort study. Gut 2019;68:969–76.
Rodriguez de Santiago E, Sanchez Aldehuelo R, Riu Pons F, et al. Endoscopy-related bleeding and thromboembolic events in patients on direct oral anticoagulants or vitamin K antagonists. Clin Gastroenterol Hepatol 2022;20:e380–97.
Rabeneck L, Saskin R, Paszat LF. Onset and clinical course of bleeding and perforation after outpatient colonoscopy: A population-based study. Gastrointest Endosc 2011;73:520–3.
Heublein V, Pannach S, Daschkow K, et al. Gastrointestinal endoscopy in patients receiving novel direct oral anticoagulants: Results from the prospective Dresden NOAC registry. J Gastroenterol 2018;53:236–46.
Yan Z, Gao F, Xie J, et al. Incidence and risk factors of colorectal delayed post-polypectomy bleeding in patients taking antithrombotics. J Dig Dis 2021;22:481–7.
Kim GU, Lee S, Choe J, et al. Risk of postpolypectomy bleeding in patients taking direct oral anticoagulants or clopidogrel. Sci Rep 2021;11:2634.
Rodriguez de Santiago E, Hernandez-Tejero M, Rivero-Sanchez L, et al. Management and outcomes of bleeding within 30 Days of colonic polypectomy in a large, real-life, multicenter cohort study. Clin Gastroenterol Hepatol 2021;19:732–42.e6.
Harada H, Miyaoka Y, Yuki T, et al. Postpolypectomy bleeding of colorectal polyps in patients with continuous warfarin and short-term interruption of direct oral anticoagulants. Gastrointest Endosc 2021;93:691–8.
Ara N, Iijima K, Maejima R, et al. Prospective analysis of risk for bleeding after endoscopic biopsy without cessation of antithrombotics in Japan. Dig Endosc 2015;27:458–64.
Tompkins EL, Andrews MA, Nojima M. Continuous anticoagulation and cold snare polypectomy. Ann Intern Med 2019;171:863–4.
Yabe K, Horiuchi A, Kudo T, et al. Risk of gastrointestinal endoscopic procedure-related bleeding in patients with or without continued antithrombotic therapy. Dig Dis Sci 2021;66:1548–55.
Tomida H, Yoshio T, Igarashi K, et al. Influence of anticoagulants on the risk of delayed bleeding after gastric endoscopic submucosal dissection: A multicenter retrospective study. Gastric Cancer 2021;24:179–89.
Kubo K, Kato M, Mabe K, et al. Risk factors for delayed bleeding after therapeutic gastrointestinal endoscopy in patients receiving oral anticoagulants: A multicenter retrospective study. Digestion 2021;102:161–9.
Chebaa BR, Burgman B, Smith AD, et al. Timing of resumption of anticoagulation after polypectomy and frequency of post-procedural complications: A post-hoc analysis. Dig Dis Sci 2022;67:3210–9.
Morita A, Horiuchi I, Tanaka N, et al. Managing bleeding risk after cold snare polypectomy in patients receiving direct-acting oral anticoagulants. Gastrointest Endosc 2022;95:969–74.
Gargiulo G, Goette A, Tijssen J, et al. Safety and efficacy outcomes of double vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: A systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulant-based randomized clinical trials. Eur Heart J 2019;40:3757–67.