TY - JOUR
T1 - Endoscopy-related bleeding and thromboembolic events in patients on direct oral anticoagulants or vitamin K antagonists
AU - ENDOHEM research group of the Spanish Society of Gastrointestinal Endoscopy (SEED) and the Spanish Gastroenterology Association (AEG)
AU - Rodríguez de Santiago, Enrique
AU - Sánchez Aldehuelo, Rubén
AU - Riu Pons, Fausto
AU - Rodríguez Escaja, Carlos
AU - Fernández-Esparrach, Gloria
AU - Cañete-Ruiz, Ángel
AU - Ferre Aracil, Carlos
AU - Pérez-Corte, Daniel
AU - Ríos León, Raquel
AU - Marcos-Prieto, Héctor Miguel
AU - Delgado-Guillena, Pedro G.
AU - García-Rodríguez, Ana
AU - Guarner-Argente, Charly
AU - Muriel, Alfonso
AU - de la Fuente-Briongos, Elsa
AU - García García de Paredes, Ana
AU - Parejo-Carbonell, Sofía
AU - Téllez, Luis
AU - Senosiaín-Lalastra, Carla
AU - Burgos-Santamaría, Diego
AU - Aicart-Ramos, Marta
AU - Mateos Muñoz, Beatriz
AU - Peñas-García, Beatriz
AU - Pagano, Giulia
AU - Casals Urquiza, Gemma
AU - Urpi Ferreruela, Miguel
AU - Ángel de Jorge-Turrión, Miguel
AU - Barreiro-Alonso, Eva
AU - Fraile-López, Miguel
AU - Gómez-Outomuro, Ana
AU - Altamirano, María Isabel
AU - Núñez Esteban, Matilde
AU - Ruiz-Andreu, Mireia
AU - Arribas-Anta, Julia
AU - de Frutos, Diego
AU - Herreros-de-Tejada, Alberto
AU - Arias-Rivera, María Luisa
AU - Roldán-Fernández, Marta
AU - Marcos Martín, Ángel F.
AU - Zamora, Javier
AU - Vázquez-Sequeiros, Enrique
AU - Albillos, Agustín
AU - Foruny-Olcina, José Ramón
AU - Argüelles Longoria, Aida
AU - González González, Carmen María
AU - González-Martín, Juan Ángel
AU - Tavío-Hernádez, Eduardo
AU - Martínez-Sánchez, Alba
AU - López-Duran, Sergio
AU - Mesonero-Gismero, Francisco
N1 - Funding Information:
Funding This study was funded by the Spanish Society of Gastrointestinal Endoscopy (Beca fundación SEED 2017)
Publisher Copyright:
© 2022 AGA Institute
PY - 2022/3
Y1 - 2022/3
N2 - Background & aims: Few prospective studies have assessed the safety of direct oral anticoagulants (DOACs) in elective endoscopy. Our primary aim was to compare the risks of endoscopy-related gastrointestinal bleeding and thromboembolic events in patients on DOACs or vitamin K antagonists (VKAs) in this setting. Secondarily, we examined the impact of the timing of anticoagulant resumption on the risk of delayed bleeding in high-risk therapeutic procedures. Methods: We conducted a multicenter, prospective, observational study from January 2018 to March 2020 of 1602 patients on oral anticoagulants (1004 on VKAs and 598 on DOACs) undergoing 1874 elective endoscopic procedures. Our primary outcomes were 90-day thromboembolic events and 30-day endoscopy-related gastrointestinal bleeding. The inverse probability of treatment weighting propensity score method was used for baseline covariate adjustment. Results: The 2 groups had similar risks of endoscopy-related gastrointestinal bleeding (VKAs vs DOACs, 6.2% vs 6.7%; adjusted odds ratio [OR], 1.05; 95% CI, 0.67–1.65) and thromboembolic events (VKAs vs DOACs, 1.3% vs 1.5%; adjusted OR, 0.90; 95% CI, 0.34–2.38). In high bleeding risk procedures (n = 747), delayed anticoagulant resumption (> 48 hours or 24–48 hours vs < 24 hours) did not reduce the risk of postprocedural bleeding (10.3%, 9%, and 5.8%, respectively; adjusted P = .43). Hot and cold snare polypectomy were the most frequent high-risk interventions (41.8% and 39.8%, respectively). Conclusion: In a prospective study of patients on DOACs or VKAs undergoing elective endoscopy, endoscopy-related bleeding and thromboembolic events showed similar risk. Our study suggests that early anticoagulant resumption is safe in most patients, but more data are needed for advanced high-risk therapeutic procedures.
AB - Background & aims: Few prospective studies have assessed the safety of direct oral anticoagulants (DOACs) in elective endoscopy. Our primary aim was to compare the risks of endoscopy-related gastrointestinal bleeding and thromboembolic events in patients on DOACs or vitamin K antagonists (VKAs) in this setting. Secondarily, we examined the impact of the timing of anticoagulant resumption on the risk of delayed bleeding in high-risk therapeutic procedures. Methods: We conducted a multicenter, prospective, observational study from January 2018 to March 2020 of 1602 patients on oral anticoagulants (1004 on VKAs and 598 on DOACs) undergoing 1874 elective endoscopic procedures. Our primary outcomes were 90-day thromboembolic events and 30-day endoscopy-related gastrointestinal bleeding. The inverse probability of treatment weighting propensity score method was used for baseline covariate adjustment. Results: The 2 groups had similar risks of endoscopy-related gastrointestinal bleeding (VKAs vs DOACs, 6.2% vs 6.7%; adjusted odds ratio [OR], 1.05; 95% CI, 0.67–1.65) and thromboembolic events (VKAs vs DOACs, 1.3% vs 1.5%; adjusted OR, 0.90; 95% CI, 0.34–2.38). In high bleeding risk procedures (n = 747), delayed anticoagulant resumption (> 48 hours or 24–48 hours vs < 24 hours) did not reduce the risk of postprocedural bleeding (10.3%, 9%, and 5.8%, respectively; adjusted P = .43). Hot and cold snare polypectomy were the most frequent high-risk interventions (41.8% and 39.8%, respectively). Conclusion: In a prospective study of patients on DOACs or VKAs undergoing elective endoscopy, endoscopy-related bleeding and thromboembolic events showed similar risk. Our study suggests that early anticoagulant resumption is safe in most patients, but more data are needed for advanced high-risk therapeutic procedures.
KW - Anticoagulants
KW - Endoscopy
KW - Hemorrhage
KW - Thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85111934781&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2020.11.037
DO - 10.1016/j.cgh.2020.11.037
M3 - Article
C2 - 33279783
AN - SCOPUS:85111934781
SN - 1542-3565
VL - 20
SP - e380-e397
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -