Bleeding Risk Related to Upper Gastrointestinal Endoscopic Biopsy in Patients Receiving Antithrombotic Therapy: A Multicenter Prospective Observational Study

Abstract

BackgroundAlthough antithrombotic agents are widely used for cardiac and cerebrovascular disease prevention, they increase the risk of gastrointestinal (GI) bleeding.ObjectiveTo examine GI bleeding risk in association with an esophagogastroduodenoscopy (EGD) biopsy performed in patients without cessation of antithrombotic therapy.MethodsThis study was prospectively conducted at 14 centers. EGD biopsies were performed in patients receiving antithrombotic agents without cessation, as well as age- and sex-matched controls not receiving antithrombotic therapy. Patients treated with warfarin before the biopsy had a prothrombin time-international normalized ratio level <3.0. The proportion of GI bleeding events was compared between the groups.ResultsThe patient group (n = 277) underwent a total of 560 biopsies while continuing antithrombotic therapy, of whom 24 were receiving multiple antiplatelet drugs, and 9 were receiving both antiplatelet and anticoagulant agents. The control patients (n = 263) underwent 557 biopsies. The upper-GI bleeding rate within 30 days after the EGD biopsy did not increase in patients without cessation of antithrombotic treatment, regardless of receiving single or multiple antithrombotic agents.ConclusionsWe found no significant increase in upper-GI bleeding risk following an EGD biopsy in patients taking antithrombotic agents, suggesting its safety without the need for antithrombotic treatment interruption.

The safety of upper gastrointestinal endoscopic biopsy in patients receiving antithrombic drugs. A single-centre prospective observational study

“…In western countries, the recommended target level for PT-INR levels is between 2.0 and 3.0 [24,25]. Yuki et al [26] found in their prospective observational study that bleeding risk did not increase due to anticoagulant usage. The previously recorded mean PT-INR levels of Japanese patients using warfarin were 1.99 ±0.24 [27].…”

Anticoagulation and antiplatelet management in gastrointestinal endoscopy: A review of current evidence

“…, neoplasia, coeliac disease, Helicobacter pylori) . The risk of PPB is low, ranging from 0.12%-0.98% in published studies[ 5 - 7 ].…”

“…Continuing aspirin monotherapy in diagnostic endoscopies and colonoscopies with biopsy is associated with an overall low risk of PPB of 0.4%-0.95% from multiple published studies[ 5 - 7 , 103 - 105 ]. There is minimal additive risk in continuing aspirin, as the index bleeding risk in the absence of antiplatelet use is similar, between 0.12%-0.98% (Table 1 ).…”

“…Continued thienopyridine monotherapy is considered safe in diagnostic endoscopies and colonoscopies with biopsy. In several published studies there were no reported incidences of bleeding[ 5 - 7 , 103 - 105 ].…”

“…Continued DAPT in diagnostic endoscopies and colonoscopies with biopsy has an overall low risk of bleeding. Three studies[ 7 , 104 , 105 ] reported no incidences of PPB post biopsy. While the study by Ara et al [ 6 ] only reported one episode of bleeding post biopsy on continued DAPT (0.35%).…”