Key result
Anticoagulant use linked to ~70% higher odds of severe post-EST bleeding in choledocholithiasis.
Why the study?
Severe bleeding after endoscopic sphincterotomy and papillary balloon dilation in patients using antiplatelet agents and anticoagulants was not well characterized.
Does the use of antiplatelet agents or anticoagulants increase the risk of clinically significant bleeding in patients undergoing EST or EPBD for choledocholithiasis?
Cohort (n=61,002)
Yes
Does the use of antiplatelet agents or anticoagulants increase the risk of clinically significant bleeding in patients undergoing EST or EPBD for choledocholithiasis?
Answers are grounded in this paper and cite their sources.
Anticoagulant use, but not antiplatelet use, is associated with a significantly increased risk of severe bleeding following endoscopic sphincterotomy and papillary balloon dilation.
Background and study aims Severe bleeding is a potentially lethal complication after endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) for choledocholithiasis. This study aimed to evaluate the impact of antiplatelet agents and anticoagulants on this complication. Patients and methods Patients who underwent EST and EPBD were identified in a Japanese nationwide administrative database covering 1090 hospitals. Adjusting for other potential risk factors, we evaluated the association between oral administration of antiplatelet agents and/or anticoagulants (continuation, discontinuation, and non-use) and clinically significant bleeding within 3 days of the procedure. Results In total, 61 002 patients were analyzed (EST, 54 493 patients; EPBD, 6509). The rate of severe bleeding was 0.8 % in both groups, but EPBD was performed more frequently than EST in patients with chronic renal failure, liver cirrhosis, and in those receiving antiplatelet agents or anticoagulants. The impact of continuation/discontinuation of antiplatelet agents on severe bleeding was not statistically significant in the EST or EPBD groups. The use of anticoagulants was associated with a statistically significant increase in severe bleeding compared with non-use for EST (1.6 % 27 of 1688 patients vs. 0.8 % 429 of 52 805 patients; adjusted odds ratio [OR] 1.70; 95 % confidence interval [CI] 1.10 - 2.63) and for EPBD (3.0 % [8 of 263 patients] vs. 0.7 % 46 of 6246 patients; adjusted OR 2.91; 95 %CI 1.36 - 6.24). Conclusions EST and EPBD can be safely performed in patients receiving antiplatelet agents. Users of anticoagulants are at high risk of bleeding, and the periprocedural management of these should be further investigated.
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Hamada et al. (2015) conducted a cohort in Choledocholithiasis (n=61,002). Anticoagulant use vs. Non-use of anticoagulants was evaluated on Clinically significant severe bleeding within 3 days of the procedure (adjusted OR 1.70, 95% CI 1.10 - 2.63). Use of anticoagulants was associated with increased severe bleeding compared to non-use following EST and EPBD for choledocholithiasis.
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