Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users

Yoshiyasu Kono, Minoru Matsubara, Tatsuya Toyokawa, Ryuta Takenaka, Seiyu Suzuki, Junichirou Nasu, Masao Yoshioka, Masahiro Nakagawa, Motowo Mizuno, Hiroyuki Sakae, Makoto Abe, Tatsuhiro Gotoda, Ko Miura, Hiromitsu Kanzaki, Masaya Iwamuro, Keisuke Hori, Takao Tsuzuki, Masahide Kita, Seiji Kawano, Yoshiro Kawahara & 1 others Hiroyuki Okada

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: The Japan Gastroenterological Endoscopy Society updated its guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment in July 2012. However, the safety of endoscopic procedures in antithrombotic drug users has not been fully investigated. Aims: To evaluate the safety of upper gastrointestinal endoscopic procedures in antithrombotic drug users. Methods: From September 2013 to September 2015, patients who were taking antithrombotic drugs and who underwent upper gastrointestinal endoscopic procedures were prospectively enrolled at five hospitals. Incidences of bleeding and thrombosis during endoscopic procedures were evaluated. Results: A total of 270 patients [221 for endoscopic mucosal biopsy and 49 for endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) were enrolled. The bleeding rate was 0.9% for endoscopic mucosal biopsy and 22% for EMR/ESD, respectively. The bleeding rate after endoscopic mucosal biopsy was not significantly high, even if antithrombotic drugs were continued (0 vs. 1%, P > 0.99), while it was significantly higher among multiple antithrombotic drug users than single drug users (5.9 vs. 0%, P < 0.05). The bleeding rate after EMR/ESD was also higher among multiple antithrombotic drug users than single drug users, but was not significantly different (33 vs. 14%, P = 0.17). Moreover, there were no differences in bleeding rates according to the cessation or continuance of antithrombotic drugs (20 vs. 25%, P = 0.74). There were no thromboembolisms in all cases. Conclusions: Upper gastrointestinal endoscopic procedures performed under the new guidelines appear acceptable. However, endoscopic procedures among multiple antithrombotic drug users show a greater potential for bleeding.

Original languageEnglish
Pages (from-to)730-738
Number of pages9
JournalDigestive Diseases and Sciences
Volume62
Issue number3
DOIs
Publication statusPublished - Mar 1 2017

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Drug Users
Multicenter Studies
Prospective Studies
Safety
Hemorrhage
Biopsy
Pharmaceutical Preparations
Guidelines
Thromboembolism
Endoscopy
Endoscopic Mucosal Resection
Thrombosis
Incidence

Keywords

  • Antithrombotic drug
  • Endoscopy
  • Guidelines
  • Hemorrhage
  • Thromboembolism

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users. / Kono, Yoshiyasu; Matsubara, Minoru; Toyokawa, Tatsuya; Takenaka, Ryuta; Suzuki, Seiyu; Nasu, Junichirou; Yoshioka, Masao; Nakagawa, Masahiro; Mizuno, Motowo; Sakae, Hiroyuki; Abe, Makoto; Gotoda, Tatsuhiro; Miura, Ko; Kanzaki, Hiromitsu; Iwamuro, Masaya; Hori, Keisuke; Tsuzuki, Takao; Kita, Masahide; Kawano, Seiji; Kawahara, Yoshiro; Okada, Hiroyuki.

In: Digestive Diseases and Sciences, Vol. 62, No. 3, 01.03.2017, p. 730-738.

Research output: Contribution to journalArticle

Kono, Y, Matsubara, M, Toyokawa, T, Takenaka, R, Suzuki, S, Nasu, J, Yoshioka, M, Nakagawa, M, Mizuno, M, Sakae, H, Abe, M, Gotoda, T, Miura, K, Kanzaki, H, Iwamuro, M, Hori, K, Tsuzuki, T, Kita, M, Kawano, S, Kawahara, Y & Okada, H 2017, 'Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users', Digestive Diseases and Sciences, vol. 62, no. 3, pp. 730-738. https://doi.org/10.1007/s10620-016-4437-2
Kono, Yoshiyasu ; Matsubara, Minoru ; Toyokawa, Tatsuya ; Takenaka, Ryuta ; Suzuki, Seiyu ; Nasu, Junichirou ; Yoshioka, Masao ; Nakagawa, Masahiro ; Mizuno, Motowo ; Sakae, Hiroyuki ; Abe, Makoto ; Gotoda, Tatsuhiro ; Miura, Ko ; Kanzaki, Hiromitsu ; Iwamuro, Masaya ; Hori, Keisuke ; Tsuzuki, Takao ; Kita, Masahide ; Kawano, Seiji ; Kawahara, Yoshiro ; Okada, Hiroyuki. / Multicenter Prospective Study on the Safety of Upper Gastrointestinal Endoscopic Procedures in Antithrombotic Drug Users. In: Digestive Diseases and Sciences. 2017 ; Vol. 62, No. 3. pp. 730-738.
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AU - Kono, Yoshiyasu

AU - Matsubara, Minoru

AU - Toyokawa, Tatsuya

AU - Takenaka, Ryuta

AU - Suzuki, Seiyu

AU - Nasu, Junichirou

AU - Yoshioka, Masao

AU - Nakagawa, Masahiro

AU - Mizuno, Motowo

AU - Sakae, Hiroyuki

AU - Abe, Makoto

AU - Gotoda, Tatsuhiro

AU - Miura, Ko

AU - Kanzaki, Hiromitsu

AU - Iwamuro, Masaya

AU - Hori, Keisuke

AU - Tsuzuki, Takao

AU - Kita, Masahide

AU - Kawano, Seiji

AU - Kawahara, Yoshiro

AU - Okada, Hiroyuki

PY - 2017/3/1

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N2 - Background: The Japan Gastroenterological Endoscopy Society updated its guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment in July 2012. However, the safety of endoscopic procedures in antithrombotic drug users has not been fully investigated. Aims: To evaluate the safety of upper gastrointestinal endoscopic procedures in antithrombotic drug users. Methods: From September 2013 to September 2015, patients who were taking antithrombotic drugs and who underwent upper gastrointestinal endoscopic procedures were prospectively enrolled at five hospitals. Incidences of bleeding and thrombosis during endoscopic procedures were evaluated. Results: A total of 270 patients [221 for endoscopic mucosal biopsy and 49 for endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) were enrolled. The bleeding rate was 0.9% for endoscopic mucosal biopsy and 22% for EMR/ESD, respectively. The bleeding rate after endoscopic mucosal biopsy was not significantly high, even if antithrombotic drugs were continued (0 vs. 1%, P > 0.99), while it was significantly higher among multiple antithrombotic drug users than single drug users (5.9 vs. 0%, P < 0.05). The bleeding rate after EMR/ESD was also higher among multiple antithrombotic drug users than single drug users, but was not significantly different (33 vs. 14%, P = 0.17). Moreover, there were no differences in bleeding rates according to the cessation or continuance of antithrombotic drugs (20 vs. 25%, P = 0.74). There were no thromboembolisms in all cases. Conclusions: Upper gastrointestinal endoscopic procedures performed under the new guidelines appear acceptable. However, endoscopic procedures among multiple antithrombotic drug users show a greater potential for bleeding.

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KW - Antithrombotic drug

KW - Endoscopy

KW - Guidelines

KW - Hemorrhage

KW - Thromboembolism

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