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Direct oral anticoagulants increase bleeding risk after endoscopic sphincterotomy: a retrospective study.

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Title: Direct oral anticoagulants increase bleeding risk after endoscopic sphincterotomy: a retrospective study.
Authors: Masuda, Sakue, Koizumi, Kazuya, Nishino, Takashi, Tazawa, Tomohiko, Kimura, Karen, Tasaki, Junichi, Ichita, Chikamasa, Sasaki, Akiko, Kako, Makoto, Uojima, Haruki, Sugitani, Ayumu
Source: BMC Gastroenterology; 10/24/2021, Vol. 21 Issue 1, p1-10, 10p
Subject Terms: HEMORRHAGE, FIBRINOLYTIC agents, GASTROINTESTINAL hemorrhage, PHYSICIANS, OLDER patients, PLATELET count, ORAL drug administration, ANTICOAGULANTS, RETROSPECTIVE studies, ENDOSCOPIC gastrointestinal surgery, HEPARIN
Abstract: Background: Bleeding can be a serious adverse event of endoscopic sphincterotomy (EST). However, the risk of EST bleeding between direct oral anticoagulant (DOAC) users and those who received no antithrombotic agents has not been clarified. This study analyzed the risk factors for bleeding after EST in patients on DOAC and evaluated the Japan Gastroenterological Endoscopy Society (JGES) guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment.Methods: We retrospectively analyzed 524 patients treated with EST who received DOAC or no antithrombotic drug from May 2016 to August 2019. We investigated the risk factors for bleeding. DOAC was typically discontinued for ≤ 1-day based on the JGES guideline. Although DOAC therapy recommenced the next morning after EST in principle, the duration of DOAC cessation and heparin replacement were determined by the attending physician based on each patient's status.Results: The number of patients on DOAC (DOAC group) and those not on antithrombotic drug (no-drug group) was 42 (8.0%) and 482 (92.0%), respectively. DOAC was discontinued for ≤ 1-day in 17 (40.0%) patients and for > 1-day in 25 (60.0%). Of the 524 patients, 21 (4.0%) had EST bleeding. The bleeding rate was higher in the DOAC group (14.0%) (p = 0.004). Multivariate analysis showed that bleeding occurred more frequently in patients on DOAC (odds ratio [OR] 3.95, 95% confidence interval [CI] 1.37-11.4, p = 0.011), patients with low platelet counts (< 100,000/µl) (OR 6.74, 95% CI 2.1-21.6, p = 0.001), and elderly patients (> 80 years old) (OR 3.36, 95%CI 1.17-9.65, p = 0.024).Conclusions: DOAC treatment, low platelet count, and old age (> 80 years old) are risk factors for EST bleeding. Although the bleeding incidence increased in patients on DOAC who received antithrombotic therapy according to the JGES guidelines, successful hemostasis was achieved with endoscopy in all cases, and no thrombotic events occurred after cessation of DOAC. Thus, the JGES guidelines are acceptable. [ABSTRACT FROM AUTHOR]
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  Data: Direct oral anticoagulants increase bleeding risk after endoscopic sphincterotomy: a retrospective study.
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  Group: Au
  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Masuda%2C+Sakue%22&quot;&gt;Masuda, Sakue&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Koizumi%2C+Kazuya%22&quot;&gt;Koizumi, Kazuya&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Nishino%2C+Takashi%22&quot;&gt;Nishino, Takashi&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Tazawa%2C+Tomohiko%22&quot;&gt;Tazawa, Tomohiko&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kimura%2C+Karen%22&quot;&gt;Kimura, Karen&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Tasaki%2C+Junichi%22&quot;&gt;Tasaki, Junichi&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ichita%2C+Chikamasa%22&quot;&gt;Ichita, Chikamasa&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sasaki%2C+Akiko%22&quot;&gt;Sasaki, Akiko&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kako%2C+Makoto%22&quot;&gt;Kako, Makoto&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Uojima%2C+Haruki%22&quot;&gt;Uojima, Haruki&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sugitani%2C+Ayumu%22&quot;&gt;Sugitani, Ayumu&lt;/searchLink&gt;
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  Data: BMC Gastroenterology; 10/24/2021, Vol. 21 Issue 1, p1-10, 10p
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22HEMORRHAGE%22&quot;&gt;HEMORRHAGE&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22FIBRINOLYTIC+agents%22&quot;&gt;FIBRINOLYTIC agents&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22GASTROINTESTINAL+hemorrhage%22&quot;&gt;GASTROINTESTINAL hemorrhage&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22PHYSICIANS%22&quot;&gt;PHYSICIANS&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22OLDER+patients%22&quot;&gt;OLDER patients&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22PLATELET+count%22&quot;&gt;PLATELET count&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22ORAL+drug+administration%22&quot;&gt;ORAL drug administration&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22ANTICOAGULANTS%22&quot;&gt;ANTICOAGULANTS&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22RETROSPECTIVE+studies%22&quot;&gt;RETROSPECTIVE studies&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22ENDOSCOPIC+gastrointestinal+surgery%22&quot;&gt;ENDOSCOPIC gastrointestinal surgery&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22HEPARIN%22&quot;&gt;HEPARIN&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: &lt;bold&gt;Background: &lt;/bold&gt;Bleeding can be a serious adverse event of endoscopic sphincterotomy (EST). However, the risk of EST bleeding between direct oral anticoagulant (DOAC) users and those who received no antithrombotic agents has not been clarified. This study analyzed the risk factors for bleeding after EST in patients on DOAC and evaluated the Japan Gastroenterological Endoscopy Society (JGES) guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment.&lt;bold&gt;Methods: &lt;/bold&gt;We retrospectively analyzed 524 patients treated with EST who received DOAC or no antithrombotic drug from May 2016 to August 2019. We investigated the risk factors for bleeding. DOAC was typically discontinued for ≤ 1-day based on the JGES guideline. Although DOAC therapy recommenced the next morning after EST in principle, the duration of DOAC cessation and heparin replacement were determined by the attending physician based on each patient&#39;s status.&lt;bold&gt;Results: &lt;/bold&gt;The number of patients on DOAC (DOAC group) and those not on antithrombotic drug (no-drug group) was 42 (8.0%) and 482 (92.0%), respectively. DOAC was discontinued for ≤ 1-day in 17 (40.0%) patients and for &gt; 1-day in 25 (60.0%). Of the 524 patients, 21 (4.0%) had EST bleeding. The bleeding rate was higher in the DOAC group (14.0%) (p = 0.004). Multivariate analysis showed that bleeding occurred more frequently in patients on DOAC (odds ratio [OR] 3.95, 95% confidence interval [CI] 1.37-11.4, p = 0.011), patients with low platelet counts (&lt; 100,000/&#181;l) (OR 6.74, 95% CI 2.1-21.6, p = 0.001), and elderly patients (&gt; 80&#160;years old) (OR 3.36, 95%CI 1.17-9.65, p = 0.024).&lt;bold&gt;Conclusions: &lt;/bold&gt;DOAC treatment, low platelet count, and old age (&gt; 80&#160;years old) are risk factors for EST bleeding. Although the bleeding incidence increased in patients on DOAC who received antithrombotic therapy according to the JGES guidelines, successful hemostasis was achieved with endoscopy in all cases, and no thrombotic events occurred after cessation of DOAC. Thus, the JGES guidelines are acceptable. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label:
  Group: Ab
  Data: &lt;i&gt;Copyright of BMC Gastroenterology is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder&#39;s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1186/s12876-021-01980-6
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        Text: English
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      – SubjectFull: HEMORRHAGE
        Type: general
      – SubjectFull: FIBRINOLYTIC agents
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      – SubjectFull: GASTROINTESTINAL hemorrhage
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      – SubjectFull: HEPARIN
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      – TitleFull: Direct oral anticoagulants increase bleeding risk after endoscopic sphincterotomy: a retrospective study.
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              Text: 10/24/2021
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