Endoscopic center, Affiliated Hospital of Shaoxing University, Shao Xing 312000, Zhejiang Province, China.
Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shao Xing 312000, Zhejiang Province, China.
Thromb Res. 2024 Sep;241:109107. doi: 10.1016/j.thromres.2024.109107. Epub 2024 Jul 31.
Although anticoagulants may potentially increase the risk of post-colonoscopy bleeding events, temporary discontinuation of medications could elevate the risk of thromboembolism (TE). There is a paucity of data regarding the incidence of bleeding and TE events in patients undergoing colonoscopy while on uninterrupted or interrupted anticoagulant therapy. Therefore, we aimed to ascertain the risks of post-colonoscopy TE and bleeding in patients with continuous or interrupted use of anticoagulant agents.
The electronic databases of PubMed, Embase, and the Cochrane library were comprehensively searched from inception to March 15, 2024. We identified studies reporting the incidence of bleeding and TE events in patients undergoing colonoscopy with uninterrupted or interrupted anticoagulant therapy. The pooled incidence rate of bleeding and TE events was estimated using a random-effects model.
This study included a total of 15 studies involving 63, 017 patients. Overall, the incidence of post-procedural bleeding for uninterrupted and interrupted direct oral anticoagulants (DOACs) was found to be 3.60 % (95 % CI: 1.60 %-5.60 %), and 0.90 % (95 % CI: 0.10 %-10.30 %), respectively. Subgroup analysis revealed that older age patients (≥65 years) had a significantly higher rate of bleeding with uninterrupted DOACs therapy compared to younger age patients (< 65 years) (7.20 % vs. 2.00 %). The highest rate of bleeding was observed in Asia (7.20 %, 95 % CI: 2.20 %-12.10 %). Similarly, the risk of bleeding was significantly increased among patients interrupting DOACs therapy in Asia compared to North America (1.40 % vs. 0.26 %). For patients on uninterrupted and interrupted warfarin, a higher rate of bleeding events was observed in older age patients than younger age patients (4.90 % vs. 0.80 %, and 2.20 % vs. 1.70 %, respectively). Uninterrupted warfarin showed a more significant risk of bleeding in Asia (4.20 %, 95%CI: 1.90 %-6.60 %) compared to North America (1.00 %, 95%CI: 0.50 %-1.50 %). Among those who did not interrupt DOACs therapy, the incidence of TE was the lowest (0.08 %, 95%CI: 0.04 %-0.11 %).
This study provides a comprehensive assessment of bleeding and TE risks in patients undergoing colonoscopy while receiving uninterrupted or interrupted anticoagulant therapy in the real-world setting. The overall incidence of post-colonoscopy bleeding and TE events is relatively low. However, the uninterrupted DOACs and warfarin are associated with an elevated risk of bleeding, particularly among elderly patients and the Asian population.
抗凝剂可能会增加结肠镜检查后出血事件的风险，但停止用药可能会增加血栓栓塞（TE）的风险。目前关于接受不间断或中断抗凝治疗的患者在结肠镜检查时出血和 TE 事件的发生率的数据很少。因此，我们旨在确定连续或间断使用抗凝药物的患者行结肠镜检查后 TE 和出血的风险。
从建立到 2024 年 3 月 15 日，我们全面检索了 PubMed、Embase 和 Cochrane 图书馆的电子数据库，以确定报告不间断或中断抗凝治疗的患者结肠镜检查后出血和 TE 事件发生率的研究。使用随机效应模型估计出血和 TE 事件的总发生率。
这项研究共纳入了 15 项研究，涉及 63017 名患者。总的来说，不间断直接口服抗凝剂（DOACs）和间断 DOACs 的术后出血发生率分别为 3.60%（95%CI：1.60%-5.60%）和 0.90%（95%CI：0.10%-10.30%）。亚组分析显示，年龄较大（≥65 岁）的不间断 DOACs 治疗患者出血风险显著高于年龄较小（<65 岁）的患者（7.20%比 2.00%）。亚洲患者的出血率最高（7.20%，95%CI：2.20%-12.10%）。同样，与北美相比，中断 DOACs 治疗的亚洲患者出血风险显著增加（1.40%比 0.26%）。对于不间断和间断使用华法林的患者，年龄较大的患者出血风险高于年龄较小的患者（4.90%比 0.80%，2.20%比 1.70%）。与北美（1.00%，95%CI：0.50%-1.50%）相比，亚洲的不间断华法林显示出更高的出血风险（4.20%，95%CI：1.90%-6.60%）。不间断 DOACs 治疗的患者中，TE 的发生率最低（0.08%，95%CI：0.04%-0.11%）。
本研究在真实世界环境中全面评估了接受不间断或间断抗凝治疗的患者行结肠镜检查时的出血和 TE 风险。总的来说，结肠镜检查后出血和 TE 事件的发生率相对较低。然而，不间断的 DOACs 和华法林与出血风险增加相关，特别是在老年患者和亚洲人群中。
