Post-ERCP Bleeding in the Era of Multiple Antiplatelet Agents
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Background/Aims: This study aimed to determine the risk of post-endoscopic retrograde cholangiopancreatography (post-ERCP) bleeding among patients taking antiplatelet agents (APAs), particularly in the era of multiple APAs. Methods: The primary outcomes were the frequency, type, and severity of ERCP-related bleeding according to the use of APAs. Results: The frequencies of post-ERCP bleeding among the four different groups were 16 of 2,083 (0.8%) in the no drug group, 12 of 256 (4.7%) in the aspirin group, 3 of 48 (6.3%) in the single APA group, and 4 of 48 (8.3%) in the multiple APA group (p<0.001). In the univariate analysis, post-ERCP bleeding was associated with age, pull-type sphincterotomy, and APA and was inversely associated with balloon dilation of the biliary orifice. In the multivariate analysis, pull-type sphincterotomy (odds ratio [OR], 7.829; 95% confidence interval [CI], 1.411 to 43.453; p=0.019) and country (Korea: OR, 0.124; 95% CI, 0.042 to 0.361; p<0.001) were associated with post-ERCP bleeding. Conclusions: The frequency of post-ERCP bleeding was statistically higher in patients on any APA within 6 days prior to ERCP. However, in the multivariate analysis, APA use was not associated with post-ERCP bleeding. Until a large, adequately powered study to detect differences is performed, caution is recommended when considering invasive procedures during ERCP in patients on APAs.
Abstract
Background/Aims: This study aimed to determine the risk of post-endoscopic retrograde cholangiopancreatography (post-ERCP) bleeding among patients taking antiplatelet agents (APAs), particularly in the era of multiple APAs. Methods: The primary outcomes were the frequency, type, and severity of ERCP-related bleeding according to the use of APAs. Results: The frequencies of post-ERCP bleeding among the four different groups were 16 of 2,083 (0.8%) in the no drug group, 12 of 256 (4.7%) in the aspirin group, 3 of 48 (6.3%) in the single APA group, and 4 of 48 (8.3%) in the multiple APA group (p<0.001). In the univariate analysis, post-ERCP bleeding was associated with age, pull-type sphincterotomy, and APA and was inversely associated with balloon dilation of the biliary orifice. In the multivariate analysis, pull-type sphincterotomy (odds ratio [OR], 7.829; 95% confidence interval [CI], 1.411 to 43.453; p=0.019) and country (Korea: OR, 0.124; 95% CI, 0.042 to 0.361; p<0.001) were associated with post-ERCP bleeding. Conclusions: The frequency of post-ERCP bleeding was statistically higher in patients on any APA within 6 days prior to ERCP. However, in the multivariate analysis, APA use was not associated with post-ERCP bleeding. Until a large, adequately powered study to detect differences is performed, caution is recommended when considering invasive procedures during ERCP in patients on APAs.
참고문헌 (14)
- Freeman ML, "Complications of endoscopic biliary sphincterotomy", N Engl J Med, 335, pp.909~918 (1996)[DOI]
- Andriulli A, "Incidence rates of post-ERCP complications: a systematic survey of prospective studies", Am J Gastroenterol, 102, pp.1781~1788 (2007)[DOI]
- Cotton PB, "Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years", Gastrointest Endosc, 70, pp.80~88 (2009)[DOI]
- Freeman ML, "Adverse outcomes of ERCP", Gastrointest Endosc, 56(6 Suppl), pp.S273~S282 (2002)[DOI]
- ASGE Standards of Practice Committee, "The management of antithrombotic agents for patients undergoing GI endoscopy", Gastrointest Endosc, 83, pp.3~16 (2016)[DOI]
- Veitch AM, "Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines", Gut, 65, pp.374~389 (2016)[DOI]
- Cotton PB, "Endoscopic sphincterotomy complications and their management: an attempt at consensus", Gastrointest Endosc, 37, pp.383~393 (1991)[DOI]
- Ferreira LE, "Post-sphincterotomy bleeding: who, what, when, and how", Am J Gastroenterol, 102, pp.2850~2858 (2007)[DOI]
- Williams EJ, "Risk factors for complication following ERCP: results of a large-scale, prospective multicenter study", Endoscopy, 39, pp.793~801 (2007)[DOI]
- Wang P, "Risk factors for ERCP-related complications: a prospective multicenter study", Am J Gastroenterol, 104, pp.31~40 (2009)[DOI]
- Lee MG, "Effect of sustained use of platelet aggregation inhibitors on post-endoscopic sphincterotomy bleeding", Dig Endosc, 26, pp.737~744 (2014)[DOI]
- Loperfido S, "Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study", Gastrointest Endosc, 48, pp.1~10 (1998)[DOI]
- Masci E, "Complications of diagnostic and therapeutic ERCP: a prospective multicenter study", Am J Gastroenterol, 96, pp.417~423 (2001)[DOI]
- Disario JA, "Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones", Gastroenterology, 127, pp.1291~1299 (2004)[DOI]