A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents
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Background/Aims: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrombotic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. Methods: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. Results: Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. Conclusions: The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
Abstract
Background/Aims: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrombotic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. Methods: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. Results: Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. Conclusions: The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
참고문헌 (31)
- Hewitt MJ, "EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis", Gastrointest Endosc, 75, pp.319~331 (2012)[DOI]
- Polkowski M, "Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) technical guideline", Endoscopy, 44, pp.190~206 (2012)[DOI]
- Yasuda I, "Endoscopic ultrasound-guided fine needle aspiration biopsy for diagnosis of lymphoproliferative disorders: feasibility of immunohistological, flow cytometric, and cytogenetic assessments", Am J Gastroenterol, 107, pp.397~404 (2012)[DOI]
- Wang KX, "Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review", Gastrointest Endosc, 73, pp.283~290 (2011)[DOI]
- Furie KL, "Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation: a science advisory for healthcare professionals from the American Heart Association", American Stroke Association, 2012, pp.43, 3442~3453
- Grines CL, "Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians", Circulation, 115, pp.813~818 (2007)[DOI]
- Ara N, "Prospective analysis of risk for bleeding after endoscopic biopsy without cessation of antithrombotics in Japan", Dig Endosc, 27, pp.458~464 (2015)[DOI]
- Fujimoto K, "Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment", Dig Endosc, 26, pp.1~14 (2014)
- ASGE Standards of Practice Committee, "Management of antithrombotic agents for endoscopic procedures", Gastrointest Endosc, 70, pp.1060~1070 (2009)[DOI]
- Boustiere C, "Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline", Endoscopy, 43, pp.445~461 (2011)[DOI]
- Kien-Fong Vu C, "A prospective control study of the safety and cellular yield of EUS-guided FNA or Trucut biopsy in patients taking aspirin, nonsteroidal anti-inflammatory drugs, or prophylactic low molecular weight heparin", Gastrointest Endosc, 63, pp.808~813 (2006)[DOI]
- Dumonceau JM, "Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline", Endoscopy, 43, pp.897~912 (2011)[DOI]
- Cotton PB, "A lexicon for endoscopic adverse events: report of an ASGE workshop", Gastrointest Endosc, 71, pp.446~454 (2010)[DOI]
- Eypasch E, "Probability of adverse events that have not yet occurred: a statistical reminder", BMJ, 311, pp.619~620 (1995)[DOI]
- Hamada T, "Rarity of severe bleeding and perforation in endoscopic ultrasound-guided fine needle aspiration for submucosal tumors", Dig Dis Sci, 58, pp.2634~2638 (2013)[DOI]
- Tsuyoshi Hamada, "Severe Bleeding and Perforation Are Rare Complications of Endoscopic Ultrasound-Guided Fine Needle Aspiration for Pancreatic Masses: An Analysis of 3,090 Patients from 212 Hospitals", Gut and Liver, 8(2), pp.215~218 (2014), 거트앤리버 소화기연관학회협의회
- Inoue T, "Bleeding risk of endoscopic ultrasound-guided fine-needle aspiration in patients undergoing antithrombotic therapy", Dig Endosc, 29, pp.91~96 (2017)[DOI]
- Koh R, "Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms", Gastrointest Endosc, 78, pp.476~483 (2013)[DOI]
- Hamada T, "Bleeding after endoscopic sphincterotomy or papillary balloon dilation among users of antithrombotic agents", Endoscopy, 47, pp.997~1004 (2015)[DOI]
- Matsumoto M, "Multicenter study on hemorrhagic risk of heparin bridging therapy for periendoscopic thromboprophylaxis", BMC Gastroenterol, 15, pp.89~ (2015)[DOI]
- Douketis JD, "Perioperative bridging anticoagulation in patients with atrial fibrillation", N Engl J Med, 373, pp.823~833 (2015)[DOI]
- Ono S, "Evaluation of safety of endoscopic biopsy without cessation of antithrombotic agents in Japan", J Gastroenterol, 47, pp.770~774 (2012)[DOI]
- Granger CB, "Apixaban versus warfarin in patients with atrial fibrillation", N Engl J Med, 365, pp.981~992 (2011)[DOI]
- Schulman S, "Dabigatran versus warfarin in the treatment of acute venous thromboembolism", N Engl J Med, 361, pp.2342~2352 (2009)[DOI]
- Ono S, "Thienopyridine derivatives as risk factors for bleeding following high risk endoscopic treatments: Safe Treatment on Antiplatelets (STRAP) study", Endoscopy, 47, pp.632~637 (2015)[DOI]
- Windecker S, "2014 ESC", EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), 2014, pp.35, 2541~2619
- Levine GN, "2011 ACCF", AHA, American Heart Association Task Force on practice guidelines and the Society for Cardiovascular Angiography and Interventions, pp.Circulation, 2011[DOI]
- Colombo A, "Second-generation drugeluting stent implantation followed by 6- versus 12-month dual antiplatelet therapy: the SECURITY randomized clinical trial", J Am Coll Cardiol, 64, pp.2086~2097 (2014)[DOI]
- Gilard M, "6- versus 24-month dual antiplatelet therapy after implantation of drug-eluting stents in patients nonresistant to aspirin: the randomized, multicenter ITALIC trial", J Am Coll Cardiol, 65, pp.777~786 (2015)[DOI]
- Fujishiro M, "Multi-center survey regarding the management of anticoagulation and antiplatelet therapy for endoscopic procedures in Japan", J Gastroenterol Hepatol, 24, pp.214~218 (2009)[DOI]
- Claessen BE, "Stent thrombosis: a clinical perspective", JACC Cardiovasc Interv, 7, pp.1081~1092 (2014)