Effects of antithrombotic therapy on bleeding after endoscopic sphincterotomy: A systematic review and meta-analysis

Abstract

Background and study aims Bleeding is a common complication of following endoscopy sphincterotomy (EST), and antithrombotic therapy use during the procedure often increases risk of it. Although several guidelines have been released regarding the use of antithrombotic agents during EST, many issues about it remain controversial. We carried out a systematic review and meta-analysis to evaluate the effect of antithrombotic medication on the risk of EST bleeding.

Methods A structured literature search was carried out in Web of Science, EMBASE, PubMed, and Cochrane Library databases. RevMan 5.2 was used for meta-analysis to investigate the rate of post-EST bleeding.

Results Seven retrospective articles were included. Compared with patients who had never taken antithrombotic drugs, patients who discontinued antithrombotic drugs 1 day before the procedure had a significantly increased risk of post-EST bleeding (OR, 1.95; 95 %CI, 1.57–2.43), particularly for severe bleeding (OR, 1.83; 95 %CI, 1.44–2.34). In addition, compared with patients who discontinued antithrombotic therapy for at least 1 day, patients who continued taking antithrombotic drugs did have an increased risk of post-EST bleeding (OR, 0.70; 95 %CI, 0.40–1.23).

Conclusions The use of antithrombotic drugs may increase the bleeding rate of EST, but discontinuing therapy 1 day before endoscopy does not significantly reduce the bleeding rate.

Publikationsverlauf

Eingereicht: 26. September 2021

Angenommen nach Revision: 31. Januar 2022

Artikel online veröffentlicht:
10. Juni 2022

• References

• 1 Wiegmann AL, Khalid SI, Coogan AC. et al. Antithrombotic prescriptions for many general surgery patients significantly increases the likelihood of post-operative bleeding complications. Am J Surgery 2020; 219: 453-459
• 2 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: 1805-1812
• 3 Yoshio T, Nishida T, Kawai N. et al. Gastric ESD under heparin replacement at high-risk patients of thromboembolism is technically feasible but has a high risk of delayed bleeding: Osaka University ESD Study Group. Gastroenterol Res Pract 2013; 2013: 365830
• 4 Forsmark CE, Vege SS, Wilcox CM. Acute pancreatitis. N Engl J Med 2016; 375: 1972-1981
• 5 Tenner S, Baillie J, DeWitt J. et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013; 108: 1400-1415 ; 1416
• 6 Crockett SD, Wani S, Gardner TB. et al. American Gastroenterological Association Institute Guideline on Initial Management of Acute Pancreatitis. Gastroenterology 2018; 154: 1096-1101
• 7 Kawai K, Akasaka Y, Murakami K. et al. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc 1974; 20: 148-151
• 8 Nakajima M, Kimoto K, Fukumoto K. et al. Endoscopic sphincterotomy of the ampulla of Vater and removal of common duct stones. Am J Gastroenterol 1975; 64: 34-43
• 9 Freeman ML, Nelson DB, Sherman S. et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-918
• 10 Barthet M, Lesavre N, Desjeux A. et al. Complicaions of endoscopic sphincterotomy: results from a single tertiary referral center. Endoscopy 2002; 34: 991-997
• 11 Tulassay Z, Zagoni T, Kotrlik J. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1997; 336: 963
• 12 Huibregtse K. Complications of endoscopic sphincterotomy and their prevention. N Engl J Med 1996; 335: 961-963
• 13 Veitch AM, Vanbiervliet G, Gershlick AH. et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut 2016; 65: 374-389
• 14 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
• 15 Acosta RD, Abraham NS. ASGE Standards of Practice Committee. et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc 2016; 83: 3-16
• 16 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
• 17 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
• 18 Yamamiya A, Kitamura K, Ishii Y. et al. Safety of endoscopic sphincterotomy in patients undergoing antithrombotic treatment: a retrospective study. Therap Adv Gastrointest Endosc 2019;
• 19 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
• 20 Samie AA, Dette S, Voehringer U. et al. Endoscopic biliary sphincterotomy in patients under antithromboembolic therapy. Zeitschrift Fur Gastroenterologie 2017; 55: 841-847
• 21 Lin WC, Lin HH, Hung CY. et al. Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding. Plos One 2017;
• 22 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
• 23 Lee MG, Kim J, Lee SH. et al. Effect of sustained use of platelet aggregation inhibitors on post-endoscopic sphincterotomy bleeding. Dig Endosc 2014; 26: 737-744
• 24 Hui CK, Lai KC, Yuen MF. et al. Does withholding aspirin for one week reduce the risk of post-sphincterotomy bleeding?. Aliment Pharmacol Therap 2002; 16: 929-936
• 25 Nelson DB, Freeman ML. Major hemorrhage from endoscopic sphincterotomy: risk factor analysis. J Clin Gastroenterol 1994; 19: 283-287
• 26 Kwok A, Faigel DO. Management of anticoagulation before and after gastrointestinal endoscopy. Am J Gastroenterol 2009; 104: 3085-3097 quiz 98
• 27 Cheon YK. Continue or discontinue dual antiplatelet therapy in major surgical or endoscopic procedures. Clin Endosc 2013; 46: 315-316
• 28 Patai A, Solymosi N, Patai AV. Does rectal indomethacin given for prevention of Post-ERCP pancreatitis increase bleeding after biliary endoscopic sphincterotomy or cardiovascular mortality? post hoc analysis using prospective clinical trial data. Medicine 2014;
• 29 Yin SH, Xu P, Wang B. et al. Duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent: systematic review and network meta-analysis. BMJ 2019; 365: l2222
• 30 Quinn MJ, Fitzgerald DJ. Ticlopidine and clopidogrel. Circulation 1999; 100: 1667-1672
• 31 Le Manach Y, Kahn D, Bachelot-Loza C. et al. Impact of aspirin and clopidogrel interruption on platelet function in patients undergoing major vascular surgery. PLoS One 2014; 9: e104491
• 32 Kam PC, Nethery CM. The thienopyridine derivatives (platelet adenosine diphosphate receptor antagonists), pharmacology and clinical developments. Anaesthesia 2003; 58: 28-35
• 33 Hussain N, Alsulaiman R, Burtin P. et al. The safety of endoscopic sphincterotomy in patients receiving antiplatelet agents: a case-control study. Aliment Pharmacol Ther 2007; 25: 579-584
• 34 Abdel Samie AA, Sun R, Vöhringer U. et al. Safety of endoscopic sphincterotomy in patients under dual antiplatelet therapy. Hepatogastroenterology 2013; 60: 659-661
• 35 Abdel Samie A, Stumpf M, Sun R. et al. Biliary-pancreatic endoscopic and surgical procedures in patients under dual antiplatelet therapy: a single-center study. Clin Endosc 2013; 46: 395-398
• 36 Onal IK, Parlak E, Akdogan M. et al. Do aspirin and non-steroidal anti-inflammatory drugs increase the risk of post-sphincterotomy hemorrhage--a case-control study. Clin Res Hepatol Gastroenterol 2013; 37: 171-176
• 37 Hussain N, Alsulaiman R, Burtin P. et al. The safety of endoscopic sphincterotomy in patients receiving antiplatelet agents - a case-control study. Aliment Pharmacol Therap 2007; 25: 579-584
• 38 Tomoda T, Ueki T, Saito S. et al. The safety of endoscopic sphincterotomy in patients receiving antiplatelet therapy. Gastroenterol Endosc 2014; 56: 2150-2155
• 39 Zullo A, Hassan C, Radaelli F. Gastrointestinal endoscopy in patients on anticoagulant therapy and antiplatelet agents. Ann Gastroenterol 2017; 30: 7-14
• 40 Baron TH, Kamath PS, McBane RD. New anticoagulant and antiplatelet agents: a primer for the gastroenterologist. Clin Gastroenterol Hepatol 2014; 12: 187-195
• 41 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: 343-348
• 42 Beyer-Westendorf J, Gelbricht V, Förster K. et al. Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry. Eur Heart J 2014; 35: 1888-1896
• 43 Kjerpeseth LJ, Ellekjær H, Selmer R. et al. Trends in use of warfarin and direct oral anticoagulants in atrial fibrillation in Norway, 2010 to 2015. Eur J Clin Pharmacol 2017; 73: 1417-1425
• 44 Muro S, Kato H, Ishida E. et al. Comparison of anticoagulants and risk factors for bleeding following endoscopic sphincterotomy among anticoagulant users: Results from a large multicenter retrospective study. J Gastroenterol Hepatol 2020; 35: 37-42
• 45 Steinberg BA, Peterson ED, Kim S. et al. Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation 2015; 131: 488-494
• 46 Douketis JD, Spyropoulos AC, Kaatz S. et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 2015; 373: 823-833
• 47 Shaikh AY, McManus DD. A bridge too far? Findings of bridging anticoagulation use and outcomes in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation 2015; 131: 448-450
• 48 Lin D, Soetikno RM, McQuaid K. et al. Risk factors for postpolypectomy bleeding in patients receiving anticoagulation or antiplatelet medications. Gastrointest Endosc 2018; 87: 1106-1113
• 49 Kishida Y, Hotta K, Imai K. et al. Risk analysis of colorectal post-polypectomy bleeding due to antithrombotic agent. Digestion 2019; 99: 148-156
• 50 Paik WH, Lee SH, Ahn DW. et al. Optimal time of resuming anticoagulant after endoscopic sphincterotomy in patients at risk for thromboembolism: a retrospective cohort study. Surg Endosc Other Intervent Tech 2018; 32: 3902-3908
• 51 Sengupta N, Feuerstein JD, Patwardhan VR. et al. The risks of thromboembolism vs. recurrent gastrointestinal bleeding after interruption of systemic anticoagulation in hospitalized in patients with gastrointestinal bleeding: a prospective study. Am J Gastroenterol 2015; 110: 328-335