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ABSTRACT
Background
Gastrointestinal (GI) bleeding following endoscopic retrograde cholangiopancreatography
(ERCP) is a serious adverse event and most commonly occurs after endoscopic biliary
and/or pancreatic sphincterotomy. While the strength of available evidence for post
sphincterotomy GI bleeding risk is high for therapeutic warfarin and heparin, it remains
unknown for clopidogrel and prasugrel. We conducted a retrospective United States
(US)-based propensity-matched cohort study, to assess the risk of post sphincterotomy
bleeding in patients on anticoagulant (AC) and antiplatelet (APT) therapy.
Methods
We analyzed the US Collaborative Network in the TriNetX platform through December
27th, 2022, to include patients on APT and AC therapy who underwent ERCP within 7 days
of hospitalization. One-to-one propensity-matching was performed. The primary outcome
was the incidence of GI bleeding within 7 days of sphincterotomy. Secondary outcomes
included need for blood transfusion, intensive care unit (ICU) care, and all-cause
mortality within 30 days of bleeding.
Results
Overall, 2,806 patients (1,806 in the AC and 1000 in APT cohorts) underwent ERCP with
sphincterotomy. One-to-one (1:1) propensity score matching was performed for age,
BMI >= 30, gender, race, ethnicity, diabetes mellitus, nicotine dependence, presence
and severity of chronic kidney disease, cirrhosis, and thrombocytopenia between the
cohorts. Patients in both AC and APT cohorts had an increased risk of post sphincterotomy
bleeding compared to matched controls, adjusted odds ratio (aOR) 3.6 (95% Confidence
Interval (CI) 2.58 – 5.06) and aOR 2.2 (95% CI 1.43 – 3.56), respectively. While heparin
bridging therapy and concurrent use of aspirin did not further increase the risk of
GI bleeding, resumption of AC within 24 hours post procedure did. Patients in neither
cohort were at an increased risk for blood transfusion, ICU care or mortality.
Conclusion
Our database analysis shows that patients on AC and APT are indeed at a higher risk
of post sphincterotomy bleeding, compared to matched controls. Appropriate drug cessation
period or alternative biliary decompression modalities may be utilized in these patients.
KEYWORDS
Abbreviations:
AC (Anticoagulants), APT (Antiplatelet), ASA (Aspirin), BMI (Body Mass Index), CI (Confidence Interval), CPT (Current Procedural Terminology), DAPT (Dual Antiplatelet Therapy), EHR (Electronic Health Records), EPBD (Endoscopic Papillary Balloon Dilation), ERCP (Endoscopic Retrograde Cholangiopancreatography), EUS-BD (Endoscopic Ultrasound Guided Biliary Drainage), GI (Gastrointestinal), HCO (Healthcare Organizations), ICU (Intensive Care Unit), ICD-10-CM (International Classification of Disease, Ninth Revision and Tenth Revision, Clinical Modification), US (United States)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 23,
2023
Received in revised form:
December 28,
2022
Received:
October 8,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Grant Support: No funding was received for this study.
Disclosures:
1. Saurabh Chandan: No disclosures or conflicts of interest.
2. Aakash Desai: No disclosures or conflicts of interest.
3. Dushyant Singh Dahiya: No disclosures or conflicts of interest.
4. Daryl Ramai: No disclosures or conflicts of interest.
5. Babu P. Mohan: No disclosures or conflicts of interest.
6. Antonio Facciorusso: No disclosures or conflicts of interest.
7. Douglas G. Adler: No disclosures or conflicts of interest.
8. Gursimran S. Kochhar: No disclosures or conflicts of interest.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
