Effect of antithrombotic therapies on small bowel bleeding: an European multicenter retrospective study
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Background/Aims: Small bowel bleeding (SBB) is the main indication for videocapsule endoscopy (VCE); the diagnostic yield (DY)could be influenced by antithrombotic therapies. We explored the effects of these therapies on SBB. Methods: Consecutive patients from two centers (Milan, Italy and Sheffield, UK) who underwent VCE between March 2001 and July2020 were considered. Demographic data, clinical parameters, drug therapy, and technical characteristics of the procedure were collected. VCE findings and DY were evaluated. Results: In total, 957 patients (1,052 VCEs) underwent VCE for SBB (DY 50.6%, no retention); 27 patients (27 VCEs) received directoral anticoagulants, 87 (88 VCEs) received other anticoagulants, 115 (135 VCEs) received antiplatelet therapy, 198 (218 VCEs) receivedmonotherapy, and 31 (32 VCEs) received combined therapy. There were no differences in the completion rate, findings, and DYs betweeneach subgroup or between monotherapy and combined therapy. The overt bleeding rate was similar in all groups, even whencomparing antithrombotic users versus those not on therapy (p=0.59) or monotherapy versus combined therapy (p=0.34). Conclusions: VCE is safe and has a high clinical impact on SBB. Antithrombotic therapies did not affect DY or overt bleeding rate and,consequently, can be considered safe in terms of SBB risk.
Abstract
Background/Aims: Small bowel bleeding (SBB) is the main indication for videocapsule endoscopy (VCE); the diagnostic yield (DY)could be influenced by antithrombotic therapies. We explored the effects of these therapies on SBB. Methods: Consecutive patients from two centers (Milan, Italy and Sheffield, UK) who underwent VCE between March 2001 and July2020 were considered. Demographic data, clinical parameters, drug therapy, and technical characteristics of the procedure were collected. VCE findings and DY were evaluated. Results: In total, 957 patients (1,052 VCEs) underwent VCE for SBB (DY 50.6%, no retention); 27 patients (27 VCEs) received directoral anticoagulants, 87 (88 VCEs) received other anticoagulants, 115 (135 VCEs) received antiplatelet therapy, 198 (218 VCEs) receivedmonotherapy, and 31 (32 VCEs) received combined therapy. There were no differences in the completion rate, findings, and DYs betweeneach subgroup or between monotherapy and combined therapy. The overt bleeding rate was similar in all groups, even whencomparing antithrombotic users versus those not on therapy (p=0.59) or monotherapy versus combined therapy (p=0.34). Conclusions: VCE is safe and has a high clinical impact on SBB. Antithrombotic therapies did not affect DY or overt bleeding rate and,consequently, can be considered safe in terms of SBB risk.