Department of Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, 252-0375, Japan.
BMC Gastroenterol. 2021 Oct 24;21(1):401. doi: 10.1186/s12876-021-01980-6.
Bleeding can be a serious adverse event of endoscopic sphincterotomy (EST). However, the risk of EST bleeding between direct oral anticoagulant (DOAC) users and those who received no antithrombotic agents has not been clarified. This study analyzed the risk factors for bleeding after EST in patients on DOAC and evaluated the Japan Gastroenterological Endoscopy Society (JGES) guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment.
We retrospectively analyzed 524 patients treated with EST who received DOAC or no antithrombotic drug from May 2016 to August 2019. We investigated the risk factors for bleeding. DOAC was typically discontinued for ≤ 1-day based on the JGES guideline. Although DOAC therapy recommenced the next morning after EST in principle, the duration of DOAC cessation and heparin replacement were determined by the attending physician based on each patient's status.
The number of patients on DOAC (DOAC group) and those not on antithrombotic drug (no-drug group) was 42 (8.0%) and 482 (92.0%), respectively. DOAC was discontinued for ≤ 1-day in 17 (40.0%) patients and for > 1-day in 25 (60.0%). Of the 524 patients, 21 (4.0%) had EST bleeding. The bleeding rate was higher in the DOAC group (14.0%) (p = 0.004). Multivariate analysis showed that bleeding occurred more frequently in patients on DOAC (odds ratio [OR] 3.95, 95% confidence interval [CI] 1.37-11.4, p = 0.011), patients with low platelet counts (< 100,000/µl) (OR 6.74, 95% CI 2.1-21.6, p = 0.001), and elderly patients (> 80 years old) (OR 3.36, 95%CI 1.17-9.65, p = 0.024).
DOAC treatment, low platelet count, and old age (> 80 years old) are risk factors for EST bleeding. Although the bleeding incidence increased in patients on DOAC who received antithrombotic therapy according to the JGES guidelines, successful hemostasis was achieved with endoscopy in all cases, and no thrombotic events occurred after cessation of DOAC. Thus, the JGES guidelines are acceptable.
内镜下括约肌切开术（EST）可能会导致出血等严重不良事件。然而，直接口服抗凝剂（DOAC）使用者与未接受抗血栓药物治疗者 EST 出血风险尚未明确。本研究分析了 DOAC 使用者 EST 术后出血的危险因素，并评估了日本胃肠内镜学会（JGES）抗血栓治疗患者胃肠内镜指南。
我们回顾性分析了 2016 年 5 月至 2019 年 8 月期间接受 EST 治疗的 524 例 DOAC 或未接受抗血栓药物治疗的患者，调查了出血的危险因素。根据 JGES 指南，DOAC 通常停药时间不超过 1 天。尽管原则上 DOAC 治疗在 EST 后第二天早上重新开始，但根据每位患者的情况，停药和肝素替代的持续时间由主治医生决定。
接受 DOAC（DOAC 组）和未接受抗血栓药物（无药物组）的患者分别为 42 例（8.0%）和 482 例（92.0%）。17 例（40.0%）患者 DOAC 停药时间不超过 1 天，25 例（60.0%）患者停药时间超过 1 天。524 例患者中，21 例（4.0%）发生 EST 出血。DOAC 组出血率较高（14.0%）（p=0.004）。多变量分析显示，DOAC 使用者出血更为频繁（比值比 [OR] 3.95，95%置信区间 [CI] 1.37-11.4，p=0.011），血小板计数较低（＜100,000/µl）（OR 6.74，95%CI 2.1-21.6，p=0.001）和老年患者（＞80 岁）（OR 3.36，95%CI 1.17-9.65，p=0.024）。
DOAC 治疗、血小板计数低和年龄较大（＞80 岁）是 EST 出血的危险因素。尽管根据 JGES 指南，接受抗血栓治疗的 DOAC 使用者出血发生率增加，但所有病例均通过内镜成功止血，DOAC 停药后未发生血栓事件。因此，JGES 指南是可以接受的。
