Red pill or blue pill? Effect of antithrombotic therapies on small bowel bleeding

Aims Suspected SB bleeding (SBB) represents about 5-10% of all gastrointestinal bleeding and is the main indication for videocapsule endoscopy (VCE) [1] [2] [3]. We explored the impact of antithrombotic therapies on SBB with the use of VCE.

Methods Consecutive patients in two centres (Milan-Italy and Sheffield-UK) who underwent VCE from March 2001 to July 2020 were considered. Demographic and clinical parameters, drug therapy at the time of enteroscopy, procedure technical characteristics and adverse events were collected. VCE findings and diagnostic yield (DY) were evaluated.

Results 1756 VCEs (1497 patients) were collected, 1052 (957 patients) were performed for suspected SBB (20% overt, 80% occult) with a DY of 50.6% and no VCE retentions. 27 patients (27 VCEs) were on direct oral anticoagulants, 87 (88 VCEs) on other anticoagulants, and 115 (135 VCEs) on antiplatelet therapy. 198 patients (218 VCEs) were on monotherapy while 31 (32 VCEs) were on combined therapy. There were no differences in terms of completion rate, type of findings and DYs comparing each drug subgroup with others or with general SBB population, and monotherapy vs combined therapy (Table 1). Overt bleeding rate was similar in all the groups and general SBB population, even considering antithrombotic users vs patients not on therapy (23.2% vs 20.6%, p 0.59) or monotherapy vs combined therapy (17.9% vs 25%, p 0.34) ([Table 1]).

Table 1 Technical aspects of enteroscopies performed for suspected SBB in patients receiving antithrombotic therapies.

Conclusions This study confirms VCE as a safe technique with high clinical impact in SB bleeding. Antithrombotic therapies do not appear to affect the DY or rate of overt bleeding and consequently can be considered safe in terms of risk of SBB.

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• 2 Liao Z, Gao R, Xu C. et al. Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 2010; 71: 280-286
• 3 Hale MF, Sidhu R, McAlindon ME.. Capsule endoscopy: Current practice and future directions. World J Gastroenterol 2014; 20: 7752-7759