Krill Timothy, Li Dongming, Sood Akhil, Baliss Michelle, Abrol Robinder, Zaibaq Jenine, Parupudi Sreeram
Department of Gastroenterology and Hepatology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0570, United States.
Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States.
Dig Liver Dis. 2021 Jun;53(6):766-771. doi: 10.1016/j.dld.2021.03.033. Epub 2021 Apr 23.
BACKGROUND/AIM: Endoscopic sphincterotomy is considered high risk for post-procedure bleeding. Sphincterotomy in patients on therapeutic anticoagulation is avoided given increased bleeding risk. There is minimal data on the risk of post-sphincterotomy bleeding (PSB) among those on prophylactic anticoagulation for venous thromboembolism (VTE) prophylaxis.
We performed a retrospective case control study of all inpatient endoscopic retrograde cholangiopancreatographies (ERCPs) with a sphincterotomy at our institution between July 2016 to February 2020. Cases were divided into two groups based on administration of peri‑procedural pharmacologic VTE prophylaxis. The outcomes were the rates of PSB and VTE within 30-days of the ERCP.
A total of 369 inpatient ERCPs with a sphincterotomy were identified. 151 cases received peri‑procedural pharmacologic VTE prophylaxis and 218 did not. The mean Padua score and American Society of Anesthesiologists physical status classification were significantly greater in the prophylaxis group. PSB was statistically similar between both groups (3.3% vs. 5.5%, p=.32). VTE was statistically similar (0.7% vs. 0.5%, p=.79). Multivariate analysis did not reveal an association between PSB and peri‑procedural pharmacologic VTE prophylaxis.
Peri-procedural pharmacologic VTE prophylaxis is not associated with increased rates of PSB. These findings suggest that pharmacologic VTE prophylaxis can be safely continued in those undergoing an endoscopic sphincterotomy.
背景/目的：内镜括约肌切开术被认为术后出血风险较高。鉴于出血风险增加，正在接受治疗性抗凝的患者应避免进行括约肌切开术。关于接受预防性抗凝以预防静脉血栓栓塞（VTE）的患者发生括约肌切开术后出血（PSB）风险的数据极少。
我们对2016年7月至2020年2月在本机构进行的所有伴有括约肌切开术的住院内镜逆行胰胆管造影（ERCP）进行了一项回顾性病例对照研究。根据围手术期是否给予药物性VTE预防措施将病例分为两组。观察结果为ERCP术后30天内的PSB和VTE发生率。
共确定了369例接受括约肌切开术的住院ERCP病例。151例接受了围手术期药物性VTE预防，218例未接受。预防组的平均帕多瓦评分和美国麻醉医师协会身体状况分级显著更高。两组之间的PSB在统计学上相似（3.3%对5.5%，p = 0.32）。VTE在统计学上也相似（0.7%对0.5%，p = 0.79）。多因素分析未发现PSB与围手术期药物性VTE预防之间存在关联。
围手术期药物性VTE预防与PSB发生率增加无关。这些发现表明，在内镜括约肌切开术患者中可以安全地继续进行药物性VTE预防。
