Bleeding risk of endoscopic ultrasound‐guided fine‐needle aspiration in patients undergoing antithrombotic therapy

Inoue, Tadahisa; Okumura, Fumihiro; Sano, Hitoshi; Kobayashi, Yuji; Ishii, Norimitsu; Suzuki, Yuta; Fukusada, Shigeki; Kachi, Kenta; Ozeki, Takanori; Anbe, Kaiki; Iwasaki, Hiroyasu; Mizushima, Takashi; Ito, Kiyoaki; Yoneda, Masashi

doi:10.1111/den.12687

Cited by 25 publications

(13 citation statements)

References 26 publications

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“… 15 , 16 A recent retrospective study reported that EUS-FNA-related bleeding was as low in patients with antithrombotic agents as in those without them. 17 The retrospective nature of the present study, however, did not allow estimation of postoperative bleeding complications. In agreement with an earlier study, we found that 4.6% of patients undergoing EUS-FNA were taking antithrombotic agents.…”

Section: Discussionmentioning

confidence: 84%

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A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents

et al. 2018

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Background/AimsAlthough the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrom-botic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients.MethodsBetween September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed.ResultsOf the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation.ConclusionsThe rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.

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Section: Discussionmentioning

confidence: 84%

“…This finding was consistent with that of a previous study by Inoue et al . 17 Therefore, use of EUS-FNA may be feasible with continued aspirin or cilostazol.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents

et al. 2018

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“…One prospective controlled study comparing EUS-FNA and/or Trucut biopsy (TCB) in patients taking acetylsalicylic acid (ASA),non-steroidal anti-inflammatory drugs (NSAIDs) and low-molecular-weight heparin (LMWH) found that risk of bleeding in patients on antithrombotics was 33.3 %, compared to 3.7 % in a control group 5 . A recent retrospective study from Japan included 746 patients, of whom 130 were receiving antithrombotic therapy (ASA or cilostazol), and recorded only 1 case of bleeding in the antithrombotic group 6 .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of EUS-FNA in patients receiving antithrombotic therapy

et al. 2019

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Background and study aims To investigate bleeding risk and thromboembolic risk in patients receiving antithrombotic therapy who underwent endoscopic ultrasound-guided fine-needls aspiration (EUS-FNA). Patients and methods A single-center retrospective study of 908 consecutive patients undergoing EUS-FNA for pancreatic and non-pancreatic lesions patients between March 2013 and March 2017 was performed. Antithrombotic management was classified into three groups: continuous, discontinuation, and heparin replacement. Results A total of 114 patients (12.6 %) were on antithrombotic drugs and 794 (84.6 %) were not. There were six cases of significant bleeding (0.7 %) four in the antithrombotic group (0.4 %) and two (0.2 %) in the non-antithrombotic group, (odds ratio, 9.59; 95 % confidence interval, 2.12 – 43.1; P = 0.006). Of the four cases in the antithrombotic group, two were on continuous treatment, one was on discontinuation treatment and one was on heparin replacement. All cases of non-significant bleeding occurred in the non-antithrombotic group (3 peri-tumoral hematomas, 1 submucosal hematoma, and 1 intraluminal bleed). The sole thromboembolic event (0.9 %) was a cerebral infarction in the antithrombotic group in a patient on thienopyridine who switched to aspirin before the procedure. Conclusions There was a slight increase in risk of bleeding in patients receiving antithrombotic therapy especially postoperative bleeding; however, there were no cases of severe bleeding was seen and only one case of cerebral infarction which occurred in a high-risk thromboembolic patients. We concluded that EUS-FNA in a safe procedure for patients on antithrombotics, even when antithrombotic therapy is not discontinued during EUS-FNA.

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“…Bleeding events were few, despite aspirin or cilostazol continuation. [82] Although EUS-FNA of solid lesions during clopidogrel use similarly may not place patients at high risk of bleeding,[83] discontinuation of low-molecular-weight heparins should be considered in advance of these procedures. [84]…”

Section: Complicationsmentioning

confidence: 99%

Clinical use of endoscopic ultrasound-guided fine-needle aspiration: Guidelines and recommendations from Chinese Society of Digestive Endoscopy

et al. 2017

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Bleeding risk of endoscopic ultrasound‐guided fine‐needle aspiration in patients undergoing antithrombotic therapy

Abstract: The present study found a low incidence of EUS-FNA-related bleeding in patients receiving antithrombotic treatment. The bleeding event rate was low even in patients who underwent EUS-FNA while continuing aspirin or cilostazol.

Cited by 25 publications

References 26 publications

A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents

A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents

Outcomes of EUS-FNA in patients receiving antithrombotic therapy

Clinical use of endoscopic ultrasound-guided fine-needle aspiration: Guidelines and recommendations from Chinese Society of Digestive Endoscopy

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