Multicenter study on hemorrhagic risk of heparin bridging therapy for periendoscopic thromboprophylaxis

Abstract

BackgroundFor endoscopic interventions, heparin bridging therapy is recommended in patients who are at high risk from interruption of antithrombotic therapy. Although heparin bridging has been reported to be effective in preventing thrombosis, several reports have raised concerns about increased risk of bleeding. The aim of this study was to clarify complications of hepari bridging therapy in therapeutic endoscopy.MethodsA nationwide multicenter survey using questionnaire was performed about patients undergoing therapeutic endoscopy with heparin bridging. Patients who underwent therapeutic endoscopy without heparin bridging therapy were considered as controls. Compliance scores of heparin bridging therapy guideline were employed, and association was analyzed between the score and occurrence of post-procedural bleeding.ResultsThe incidence of post-procedural bleeding was significantly higher (13.5 %, 33/245) in the heparin group compared with the control group (2.7 %, 299/11102)(p < 0.001). Thrombosis occurred in 1 patient each in the two groups. In the heparin group, post-procedural bleeding was more likely to be delayed bleeding. Dose adjustment of heparin was a significant factor contributing to bleeding. The compliance score of heparin bridging therapy guideline was significantly higher in those who suffered bleeding.ConclusionsHeparin bridging therapy significantly increased the risk of post-procedural bleeding compared with the control. The bleeding risk was associated with greater adherence with guidelines for heparin bridging therapy.

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

“…It is known that heparin bridging therapy significantly increases the risk of post-procedural bleeding [10-13]. Horiuchi et al [14] reported that delayed bleeding requiring hemostasis occurs significantly less commonly after CSP than after HP despite continuation of warfarin.…”

Risk Analysis of Colorectal Post-Polypectomy Bleeding Due to Antithrombotic Agent

“…Among the antithrombotic agents, HB therapy has been reported to be a strong risk factor for PPB [7,15,30,31]. Ishigami et al [31] reported that the OR of PPB in patients treated with HB was 9.8 compared with that of patients without antithrombotic treatment.…”

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

“…Heparin replacement is useful to prevent thromboembolisms in patients undergoing invasive endoscopic procedures . However, several reports of endoscopic mucosal resection and endoscopic submucosal dissection have indicated that heparin replacement significantly increased the risk of post‐procedural bleeding . In EUS‐FNA, the above‐mentioned report indicated that bleeding events increased to 33.3 % (2/6) in patients continuing low molecular weight heparin.…”

“…Although the bleeding event rate was 0 % in patients with heparin replacement in the present study, the timing of restarting heparin varied for each patient, and many cases did not conform to the timing recommended by the recent guidelines, which recommend restarting heparin soon after the procedure. Matsumoto et al reported that greater adherence to the guidelines for heparin replacement was associated with an increased bleeding risk following endoscopic mucosal resection and endoscopic submucosal dissection . Restarting heparin administration soon after EUS‐FNA may similarly increase the bleeding risk.…”