Comparison of anticoagulants and risk factors for bleeding following endoscopic sphincterotomy among anticoagulant users

Results from a large multicenter retrospective study

Shinichiro Muro, Hironari Katou, Etsuji Ishida, Toru Ueki, Masakuni Fujii, Ryo Harada, Hiroyuki Seki, Ken Hirao, Masaki Wato, Yutaka Akimoto, Masahiro Takatani, Hirofumi Tsugeno, Jiro Miyaike, Tatsuya Toyokawa, Mamoru Nishimura, Naoko Yunoki, Hiroyuki Okada

Research output: Contribution to journalArticle

Abstract

Background and Aim: Bleeding is an inevitable and often severe complication after endoscopic sphincterotomy (EST). We aimed to investigate the factors associated with post-EST bleeding in patients treated with anticoagulants. Methods: The data of patients who underwent EST at 15 hospitals between July 2015 and June 2017 were extracted. We investigated the incidence of post-EST bleeding and risk factors for bleeding in patients treated with anticoagulants. Results: One hundred forty-nine patients undergoing EST who met the inclusion criteria were included in this study. The total-EST bleeding (bleeding occurring during or after EST) rate did not differ between the heparin replacement (8.0%, 6/75) and continuation (16.6%, 2/12; P = 0.37) groups of warfarin users. The total-EST-bleeding rate in the heparin replacement group (12.9%, 4/31) was significantly higher than that in the continuation group (0%, 0/31; P = 0.016) in direct oral anticoagulant (DOAC) users. The rate of total-EST bleeding with continuation of DOAC (0%, 0/31) was significantly lower with continuation of warfarin (16.6%, 2/12; P = 0.021). During-EST bleeding (bleeding occurring during EST) (P = 0.0083) and precut (P = 0.033) were significant risk factors for post-EST bleeding in all 149 patients. Heparin replacement was only a significant risk factor for total-EST bleeding (P = 0.033) in DOAC users. Conclusion: Heparin replacement was a significant risk factor for post-EST bleeding in DOAC users; however, there was no significant difference between the bleeding rate of heparin replacement and that of continuation groups in patients taking warfarin. During EST and precut were significant risk factors for post-EST bleeding in all patients treated with anticoagulants.

Original languageEnglish
JournalJournal of Gastroenterology and Hepatology (Australia)
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Endoscopic Sphincterotomy
Anticoagulants
Multicenter Studies
Retrospective Studies
Hemorrhage
Heparin
Warfarin

Keywords

  • delayed hemorrhage
  • DOAC
  • endoscopic sphincterotomy
  • heparin replacement
  • warfarin

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Comparison of anticoagulants and risk factors for bleeding following endoscopic sphincterotomy among anticoagulant users : Results from a large multicenter retrospective study. / Muro, Shinichiro; Katou, Hironari; Ishida, Etsuji; Ueki, Toru; Fujii, Masakuni; Harada, Ryo; Seki, Hiroyuki; Hirao, Ken; Wato, Masaki; Akimoto, Yutaka; Takatani, Masahiro; Tsugeno, Hirofumi; Miyaike, Jiro; Toyokawa, Tatsuya; Nishimura, Mamoru; Yunoki, Naoko; Okada, Hiroyuki.

In: Journal of Gastroenterology and Hepatology (Australia), 01.01.2019.

Research output: Contribution to journalArticle

Muro, Shinichiro ; Katou, Hironari ; Ishida, Etsuji ; Ueki, Toru ; Fujii, Masakuni ; Harada, Ryo ; Seki, Hiroyuki ; Hirao, Ken ; Wato, Masaki ; Akimoto, Yutaka ; Takatani, Masahiro ; Tsugeno, Hirofumi ; Miyaike, Jiro ; Toyokawa, Tatsuya ; Nishimura, Mamoru ; Yunoki, Naoko ; Okada, Hiroyuki. / Comparison of anticoagulants and risk factors for bleeding following endoscopic sphincterotomy among anticoagulant users : Results from a large multicenter retrospective study. In: Journal of Gastroenterology and Hepatology (Australia). 2019.
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abstract = "Background and Aim: Bleeding is an inevitable and often severe complication after endoscopic sphincterotomy (EST). We aimed to investigate the factors associated with post-EST bleeding in patients treated with anticoagulants. Methods: The data of patients who underwent EST at 15 hospitals between July 2015 and June 2017 were extracted. We investigated the incidence of post-EST bleeding and risk factors for bleeding in patients treated with anticoagulants. Results: One hundred forty-nine patients undergoing EST who met the inclusion criteria were included in this study. The total-EST bleeding (bleeding occurring during or after EST) rate did not differ between the heparin replacement (8.0{\%}, 6/75) and continuation (16.6{\%}, 2/12; P = 0.37) groups of warfarin users. The total-EST-bleeding rate in the heparin replacement group (12.9{\%}, 4/31) was significantly higher than that in the continuation group (0{\%}, 0/31; P = 0.016) in direct oral anticoagulant (DOAC) users. The rate of total-EST bleeding with continuation of DOAC (0{\%}, 0/31) was significantly lower with continuation of warfarin (16.6{\%}, 2/12; P = 0.021). During-EST bleeding (bleeding occurring during EST) (P = 0.0083) and precut (P = 0.033) were significant risk factors for post-EST bleeding in all 149 patients. Heparin replacement was only a significant risk factor for total-EST bleeding (P = 0.033) in DOAC users. Conclusion: Heparin replacement was a significant risk factor for post-EST bleeding in DOAC users; however, there was no significant difference between the bleeding rate of heparin replacement and that of continuation groups in patients taking warfarin. During EST and precut were significant risk factors for post-EST bleeding in all patients treated with anticoagulants.",
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author = "Shinichiro Muro and Hironari Katou and Etsuji Ishida and Toru Ueki and Masakuni Fujii and Ryo Harada and Hiroyuki Seki and Ken Hirao and Masaki Wato and Yutaka Akimoto and Masahiro Takatani and Hirofumi Tsugeno and Jiro Miyaike and Tatsuya Toyokawa and Mamoru Nishimura and Naoko Yunoki and Hiroyuki Okada",
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T1 - Comparison of anticoagulants and risk factors for bleeding following endoscopic sphincterotomy among anticoagulant users

T2 - Results from a large multicenter retrospective study

AU - Muro, Shinichiro

AU - Katou, Hironari

AU - Ishida, Etsuji

AU - Ueki, Toru

AU - Fujii, Masakuni

AU - Harada, Ryo

AU - Seki, Hiroyuki

AU - Hirao, Ken

AU - Wato, Masaki

AU - Akimoto, Yutaka

AU - Takatani, Masahiro

AU - Tsugeno, Hirofumi

AU - Miyaike, Jiro

AU - Toyokawa, Tatsuya

AU - Nishimura, Mamoru

AU - Yunoki, Naoko

AU - Okada, Hiroyuki

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background and Aim: Bleeding is an inevitable and often severe complication after endoscopic sphincterotomy (EST). We aimed to investigate the factors associated with post-EST bleeding in patients treated with anticoagulants. Methods: The data of patients who underwent EST at 15 hospitals between July 2015 and June 2017 were extracted. We investigated the incidence of post-EST bleeding and risk factors for bleeding in patients treated with anticoagulants. Results: One hundred forty-nine patients undergoing EST who met the inclusion criteria were included in this study. The total-EST bleeding (bleeding occurring during or after EST) rate did not differ between the heparin replacement (8.0%, 6/75) and continuation (16.6%, 2/12; P = 0.37) groups of warfarin users. The total-EST-bleeding rate in the heparin replacement group (12.9%, 4/31) was significantly higher than that in the continuation group (0%, 0/31; P = 0.016) in direct oral anticoagulant (DOAC) users. The rate of total-EST bleeding with continuation of DOAC (0%, 0/31) was significantly lower with continuation of warfarin (16.6%, 2/12; P = 0.021). During-EST bleeding (bleeding occurring during EST) (P = 0.0083) and precut (P = 0.033) were significant risk factors for post-EST bleeding in all 149 patients. Heparin replacement was only a significant risk factor for total-EST bleeding (P = 0.033) in DOAC users. Conclusion: Heparin replacement was a significant risk factor for post-EST bleeding in DOAC users; however, there was no significant difference between the bleeding rate of heparin replacement and that of continuation groups in patients taking warfarin. During EST and precut were significant risk factors for post-EST bleeding in all patients treated with anticoagulants.

AB - Background and Aim: Bleeding is an inevitable and often severe complication after endoscopic sphincterotomy (EST). We aimed to investigate the factors associated with post-EST bleeding in patients treated with anticoagulants. Methods: The data of patients who underwent EST at 15 hospitals between July 2015 and June 2017 were extracted. We investigated the incidence of post-EST bleeding and risk factors for bleeding in patients treated with anticoagulants. Results: One hundred forty-nine patients undergoing EST who met the inclusion criteria were included in this study. The total-EST bleeding (bleeding occurring during or after EST) rate did not differ between the heparin replacement (8.0%, 6/75) and continuation (16.6%, 2/12; P = 0.37) groups of warfarin users. The total-EST-bleeding rate in the heparin replacement group (12.9%, 4/31) was significantly higher than that in the continuation group (0%, 0/31; P = 0.016) in direct oral anticoagulant (DOAC) users. The rate of total-EST bleeding with continuation of DOAC (0%, 0/31) was significantly lower with continuation of warfarin (16.6%, 2/12; P = 0.021). During-EST bleeding (bleeding occurring during EST) (P = 0.0083) and precut (P = 0.033) were significant risk factors for post-EST bleeding in all 149 patients. Heparin replacement was only a significant risk factor for total-EST bleeding (P = 0.033) in DOAC users. Conclusion: Heparin replacement was a significant risk factor for post-EST bleeding in DOAC users; however, there was no significant difference between the bleeding rate of heparin replacement and that of continuation groups in patients taking warfarin. During EST and precut were significant risk factors for post-EST bleeding in all patients treated with anticoagulants.

KW - delayed hemorrhage

KW - DOAC

KW - endoscopic sphincterotomy

KW - heparin replacement

KW - warfarin

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