Prospective analysis of risk for bleeding after endoscopic biopsy without cessation of antithrombotics in <scp>J</scp>apan

Ara, Nobuyuki; Iijima, Katsunori; Maejima, Ryuhei; Kondo, Yutaka; Kusaka, Gen; Hatta, Waku; Uno, Kaname; Asano, Naoki; Koike, Tomoyuki; Imatani, Akira; Shimosegawa, Tooru

doi:10.1111/den.12407

Cited by 25 publications

(35 citation statements)

References 34 publications

(60 reference statements)

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“…However, that was a single-arm study conducted at a single center. Another prospective study also demonstrated that continuation of antithrombotic agents did not increase bleeding risk after an EGD biopsy 29 . Nevertheless, although that was a multicenter investigation, several factors, including age and gender, were different between the comparison groups.…”

Section: Discussionmentioning

confidence: 94%

“…Although several reports have indicated that aspirin alone in standard doses does not increase the rate of bleeding after an endoscopic biopsy,28, 29, 30 few prospective studies have appropriately evaluated the safety of antithrombotic therapy in patients undergoing an EGD biopsy. Ono et al 28 investigated hemostasis as well as late-phase bleeding risk in patients taking antithrombotic agents up to 2 weeks after an EGD biopsy, and found a low level of risk for either event in patients who continued antithrombotic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…First, the sample size was relatively small. Previous studies have indicated that upper-GI bleeding related to a biopsy procedure is rare regardless of current administration of antithrombotic agents27, 28, 29, 30; thus, studies with a much larger scale are necessary to thoroughly investigate the proportion of patients taking antithrombotic agents who experience that complication and its risk compared with a control group. Unfortunately, we were not able to conduct such an investigation with an appropriate sample size to fully evaluate the study purpose.…”

Section: Discussionmentioning

confidence: 99%

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

Yuki

Ishihara

Yashima

et al. 2017

Current Therapeutic Research

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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.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Yuki

Ishihara

Yashima

et al. 2017

Current Therapeutic Research

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“…La incidencia de sangrado no varía mucho en comparación con la de los pacientes a los que se les suspende la terapia antitrombótica (27). el mismo día del procedimiento.…”

Section: Riesgo De Sangradounclassified

Procedimientos endoscópicos y terapias antitrombóticas, una visión actual

Ortíz

Segura²,

Acuña³

et al. 2017

Rev. Colomb. Gastroenterol.

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En los últimos años se ha generado un avance importante en el tratamiento de las patologías procoagulantes con antiguos y nuevos medicamentos y se ha logrado un importante avance en los métodos diagnósticos y terapéuticos en la endoscopia digestiva. Por otra parte, la expectativa de vida de la población mundial se ha incrementado de forma considerable, por lo que más frecuentemente el gastroenterólogo debe realizar procedimientos endoscópicos, en pacientes de mayor edad, quienes presentan comorbilidades por las que reciben terapias antitrombóticas, especialmente por patologías cardiovasculares.En la literatura aparecen muchas guías de manejo avaladas por importantes asociaciones, en las que se orienta en la realización de procedimientos endoscópicos en los pacientes sometidos a terapias antitrombóticas, procedimientos que representan un determinado riesgo de sangrado, o trombosis en caso de la suspensión de los medicamentos, pero no se han realizado estudios prospectivos o controlados que permitan formular protocolos para las diversas técnicas endoscópicas diagnósticas o terapéuticas en estos pacientes. El gastroenterólogo debe realizar un balance entre el riesgo hemorrágico y el riesgo embólico para determinar cuál es el momento más indicado para realizar un procedimiento endoscópico en estos pacientes, por lo tanto, es de gran importancia que tenga conocimiento de este tema.Presentamos una revisión actualizada de la literatura y las más recientes recomendaciones de la sociedad europea de gastroenterología.

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“…Furthermore, several reports have been published concerning the clinical feasibility of endoscopic biopsy without antithrombotic discontinuation, particularly in Japan where the use of endoscopic biopsy without antithrombotic discontinuation was only recently permitted. 17,18) Although there is no solid evidence concerning the safety of other procedures with low bleeding risk without antithrombotic discontinuation, it is thought that their risk is not significantly higher than that of endoscopic biopsy. As long as procedures are performed carefully, they can be assumed to be safe to perform without antithrombotic discontinuation, as recommended by many guidelines.…”

Section: Biopsy and Low Bleeding Risk Proceduresmentioning

confidence: 99%

Current Practices in the Management of Antithrombotic Therapy During the Periendoscopic Period for Patients With Cardiovascular Disease

et al. 2016

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SummaryThe management of antithrombotics during the periendoscopic period is traditionally represented as a doubleedged sword for cardiologists and endoscopists. Appropriate administration prevents thromboembolic events, whereas excessive administration provokes bleeding events. Therefore, cardiologists and endoscopists must consider the risks of bleeding and thromboembolism in individual cases, before deciding whether to continue antithrombotic use. Several guidelines exist concerning antithrombotic management in Asian and Western countries. These guidelines generally classify procedural bleeding risk and thromboembolic risk into high risk and low risk groups and recommend that the two risks be weighed when managing a given patient. Moreover, they generally do not recommend interrupting antithrombotics during the periendoscopic period unless absolutely necessary; however, the details surrounding this point differ among the guidelines after several revisions. In this review, we describe the present state, problems, and future perspectives concerning the management of antithrombotics in patients with cardiovascular disease undergoing gastrointestinal endoscopy. (Int Heart J 2016; 57: 530-534)

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Prospective analysis of risk for bleeding after endoscopic biopsy without cessation of antithrombotics in Japan

Abstract: This prospective study showed that continuation of antithrombotics did not increase the bleeding risk after upper gastrointestinal endoscopic biopsy.

Cited by 25 publications

References 34 publications

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

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

Procedimientos endoscópicos y terapias antitrombóticas, una visión actual

Current Practices in the Management of Antithrombotic Therapy During the Periendoscopic Period for Patients With Cardiovascular Disease

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