Shinichiro Muro1, Hironari Kato1, Etsuji Ishida2, Toru Ueki3, Masakuni Fujii4, Ryo Harada5, Hiroyuki Seki6, Ken Hirao7, Masaki Wato8, Yutaka Akimoto9, Masahiro Takatani10, Hirofumi Tsugeno11, Jiro Miyaike12, Tatsuya Toyokawa13, Mamoru Nishimura14, Naoko Yunoki15, Hiroyuki Okada1. 1. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 2. Department of Gastroenterology, Kurashiki Central Hospital, Kurashiki, Japan. 3. Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan. 4. Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan. 5. Department of Gastroenterology, Okayama Red Cross General Hospital. 6. Department of Internal Medicine, Mitoyo General Hospital, Kannonji, Japan. 7. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. 8. Department of Internal Medicine, Kagawa Prefectural Central Hospital, Takamatsu, Japan. 9. Department of Gastroenterology, National Hospital Organization Iwakuni Medical Center, Iwakuni, Japan. 10. Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan. 11. Department of Internal Medicine, Tsuyama Central Hospital, Tsuyama, Japan. 12. Department of Internal Medicine, Saiseikai Imabari General Hospital, Imabari, Japan. 13. Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan. 14. Department of Gastroenterology, Okayama City Okayama Citizens Hospital, Okayama, Japan. 15. Department of Internal Medicine, Akaiwa Medical Association Hospital, Akaiwa, Japan.
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.
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.