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Войти в исследования Digestion · 2026
Association between Antithrombotic Drug Management and Bleeding during High-Risk Endoscopic Procedures: A Multicenter Retrospective Observational Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Imai Makoto, Aoki Tomonori, Niikura Ryota, Furukawa Kazuhiro, Toda Nobuo, Kim Yuntae, Ogura Keiji, Okamura Takuma, Hasatani Kenkei, Yoshida Naohiro, Sumiyoshi Tetsuya, Nishida Tsutomu, Kiyotoki Shu, Arai Masahiro, Ikeda Takaaki, Motomura Yasuaki, Yamada Seishi, Kurasawa Miwa, Otsuka Eiji, Iwata Tomoyuki, Komatsu Kazuto, Suzuki Nobumi, Hayakawa Yoku, Fujishiro Mitsuhiro
Аннотация
INTRODUCTION: Optimal management of antithrombotic drugs (ATDs) is essential to minimize bleeding during high-risk endoscopic procedures. This study aimed to investigate periprocedural ATD strategies to reduce 30-day post-procedural bleeding.
METHODS: We performed a multicenter, retrospective cohort study on high-risk endoscopic procedures. The primary outcome was 30-day bleeding requiring endoscopic hemostasis. We categorized the peri-procedure management of ATDs into continuation, discontinuation, and replacement. We evaluated the risk differences in 30-day bleeding among ATD management groups, as compared to patients who did not take ATDs (nonusers).
RESULTS: High-risk upper-GI procedures included 1,365 esophageal ESDs, 788 elective EVLs, 5,391 gastric ESDs, and 2,562 PEGs; lower-GI procedures included 23,326 colonic polypectomy/EMRs and 2,769 colonic ESDs. ATD management included aspirin continuation (n = 818) and discontinuation (n = 62); thienopyridine discontinuation (n = 188) and replacement (n = 97); warfarin continuation (n = 97) and discontinuation (n = 20); DOAC discontinuation (n = 487). Thirty-day bleeding occurred in 5.89% of upper-GI and 1.22% of lower-GI procedures. Bleeding risk differed according to ATD management. In upper-GI procedures, numerically higher bleeding rates were observed in some antithrombotic management groups, particularly aspirin continuation and thienopyridine discontinuation during gastric ESD, compared with nonusers; however, the absolute risk differences were within 10%. In contrast, bleeding risk differences in lower-GI procedures were smaller overall and within 5%.
CONCLUSION: This multicenter study describes differential bleeding risk patterns across high-risk endoscopic procedures among patients receiving antithrombotic therapy.
METHODS: We performed a multicenter, retrospective cohort study on high-risk endoscopic procedures. The primary outcome was 30-day bleeding requiring endoscopic hemostasis. We categorized the peri-procedure management of ATDs into continuation, discontinuation, and replacement. We evaluated the risk differences in 30-day bleeding among ATD management groups, as compared to patients who did not take ATDs (nonusers).
RESULTS: High-risk upper-GI procedures included 1,365 esophageal ESDs, 788 elective EVLs, 5,391 gastric ESDs, and 2,562 PEGs; lower-GI procedures included 23,326 colonic polypectomy/EMRs and 2,769 colonic ESDs. ATD management included aspirin continuation (n = 818) and discontinuation (n = 62); thienopyridine discontinuation (n = 188) and replacement (n = 97); warfarin continuation (n = 97) and discontinuation (n = 20); DOAC discontinuation (n = 487). Thirty-day bleeding occurred in 5.89% of upper-GI and 1.22% of lower-GI procedures. Bleeding risk differed according to ATD management. In upper-GI procedures, numerically higher bleeding rates were observed in some antithrombotic management groups, particularly aspirin continuation and thienopyridine discontinuation during gastric ESD, compared with nonusers; however, the absolute risk differences were within 10%. In contrast, bleeding risk differences in lower-GI procedures were smaller overall and within 5%.
CONCLUSION: This multicenter study describes differential bleeding risk patterns across high-risk endoscopic procedures among patients receiving antithrombotic therapy.