Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy

Abstract

Background/Aims: The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage (EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy is uncertain. Therefore, this study aimed to assess the bleeding risk in patients undergoing antithrombotic therapy. Methods: This single-center retrospective study included 220 consecutive patients who underwent EUS-BD between January 2013 and December 2018. We managed the withdrawal and continuation of antithrombotic agents according to the JGES guidelines. We compared the bleeding event rates among patients who received and those who did not receive antithrombotic agents. Results: A total of 18 patients (8.1 %) received antithrombotic agents and 202 patients (91.8 %) did not. Three patients experienced bleeding events, with an overall bleeding event rate of 1.3% (3/220): one patient was in the antithrombotic group (5.5%) and two patients were in the non-antithrombotic group (0.9%) (p=0.10). All cases were moderate. The sole thromboembolic event (0.4%) was a cerebral infarction in a patient in the non-antithrombotic group. Conclusions: The rate of EUS-BD-related bleeding events was low. Even in patients receiving antithrombotic therapy, the bleeding event rates were not significantly different from those in patients not receiving antithrombotic therapy. Clin Endosc 2021 Feb 17.

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

“…Therefore, we need to strengthen the treatment for acute coronary syndrome. Oral anticoagulants can reduce the risk of stroke and systemic embolism [ 29 ]. The effects of the two cannot be replaced by each other, but the combination of these two kinds of drugs increases the risk of bleeding, so how to find the balance of antithrombotic therapy in these patients is very important, and the risk of bleeding and thrombus needs to be fully assessed to maximize the benefit of patients.…”

B2 puncture with forward-viewing EUS simplifies EUS-guided hepaticogastrostomy (with video)

“…We have previously reported an association of the use of cautery dilation with bleeding in EUS-BD. [ 27 ] It is noteworthy that none of the present patients required cautery dilation. Another study that compared cautery and mechanical dilation found no significant difference in terms of technical success rates: procedure-related bleeding developed in 6 (18%) patients with cautery dilation and in none during mechanical dilation ( P = 0.04).…”

International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy

“… 65 , 74 , 79 - 81 , 84 , 85 , 88 , 93 , 94 , 96 , 100 Some studies have advocated for continuing warfarin therapy before and after therapeutic procedures. 59 , 62 , 82 , 83 , 86 , 87 , 89 , 90 , 92 , 95 , 97 - 99 However, most of these studies were conducted in Japan, and their retrospective nature hampered changes in previous statements. 59 , 82 , 83 , 86 , 89 , 90 , 92 , 95 , 97 , 98 Considering that temporary interruption of anticoagulation therapy during procedures was associated with a significantly higher risk of thromboembolic events 53 and continuing antithrombotic therapy was associated with a significantly higher risk of procedure-related bleeding, 91 we still need to stratify the patients’ thromboembolic risk, and heparin bridging therapy is recommended for only patients with a high thromboembolic risk.…”