Endoscopy-Related Bleeding and Thromboembolic Events in Patients on Direct Oral Anticoagulants or Vitamin K Antagonists
Por:
de Santiago, ER, Aldehuelo, RS, Pons, FR, Escaja, CR, Fernandez-Esparrach, G, Canete-Ruiz, A, Aracil, CF, Perez-Corte, D, Leon, RR, Marcos-Prieto, HM, Delgado-Guillena, PG, Garcia-Rodriguez, A, Guarner-Argente, C, Muriel, A, de la Fuente-Briongos, E, de Paredes, AGG, Parejo-Carbonell, S, Tellez, L, Senosiain-Lalastra, C, Burgos-Santamaria, D, Aicart-Ramos, M, Munoz, BM, Penas-Garcia, B, Pagano, G, Urquiza, GC, Ferreruela, MU, de Jorge-Turrion, MA, Barreiro-Alonso, E, Fraile-Lopez, M, Gomez-Outomuro, A, Altamirano, MI, Esteban, MN, Ruiz-Andreu, M, Arribas-Anta, J, de Frutos, D, Herreros-de-Tejada, A, Arias-Rivera, ML, Roldan-Fernandez, M, Martin, AFM, Zamora, J, Vazquez-Sequeiros, E, Albillos, A
Publicada:
1 mar 2022
Resumen:
BACKGROUND & AIMS: Few prospective studies have assessed the safety of direct oral anticoagulants (DOACs) in elective endoscopy. Our primary aim was to compare the risks of endoscopy-related gastrointestinal bleeding and thromboembolic events in patients on DOACs or vitamin K antagonists (VKAs) in this setting. Secondarily, we examined the impact of the timing of anticoagulant resumption on the risk of delayed bleeding in high-risk therapeutic procedures.
METHODS: We conducted a multicenter, prospective, observational study from January 2018 to March 2020 of 1602 patients on oral anticoagulants (1004 on VKAs and 598 on DOACs) undergoing 1874 elective endoscopic procedures. Our primary outcomes were 90-day thromboembolic events and 30-day endoscopy-related gastrointestinal bleeding. The inverse probability of treatment weighting propensity score method was used for baseline covariate adjustment.
RESULTS: The 2 groups had similar risks of endoscopy-related gastrointestinal bleeding (VKAs vs DOACs, 6.2% vs 6.7%; adjusted odds ratio [OR], 1.05; 95% CI, 0.67-1.65) and thromboembolic events (VKAs vs DOACs, 1.3% vs 1.5%; adjusted OR, 0.90; 95% CI, 0.34-2.38). In high bleeding risk procedures (n = 747), delayed anticoagulant resumption (> 48 hours or 24-48 hours vs < 24 hours) did not reduce the risk of postprocedural bleeding (10.3%, 9%, and 5.8%, respectively; adjusted P = .43). Hot and cold snare polypectomy were the most frequent high-risk interventions (41.8% and 39.8%, respectively).
CONCLUSION: In a prospective study of patients on DOACs or VKAs undergoing elective endoscopy, endoscopyrelated bleeding and thromboembolic events showed similar risk. Our study suggests that early anticoagulant resumption is safe in most patients, but more data are needed for advanced high-risk therapeutic procedures.
Filiaciones:
de Santiago, ER:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Aldehuelo, RS:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Pons, FR:
Hosp del Mar, Dept Gastroenterol, Endoscopy Unit, Barcelona, Spain
Hosp del Mar, Med Res Inst, Barcelona, Spain
Escaja, CR:
Hosp Univ Cent Asturias, Serv Aparato Digest, Oviedo, Spain
Fernandez-Esparrach, G:
Univ Barcelona, Hosp Clin, Inst Clin Enfermedades Digest & Metabol, Gastroenterol Dept,Endoscopy Unit, Barcelona, Spain
Inst Invest Biomed August Pi & Sunyer, Barcelona, Spain
Ctr Invest Biomed Red Area Temat Enfermedades Hep, Madrid, Spain
Canete-Ruiz, A:
12 Octubre Univ Hosp, Gastroenterol Dept, Endoscopy Unit, Madrid, Spain
Aracil, CF:
Hosp Univ Puerta de Hierro, Res Inst Segovia de Arana, Gastroenterol Dept, Madrid, Spain
Perez-Corte, D:
Hosp Aviles, Dept Gastroenterol, Aviles, Spain
Leon, RR:
Hosp Gen Villalba, Serv Aparato Digest, Madrid, Spain
Marcos-Prieto, HM:
Hosp Univ Salamanca, Inst Invest Biomed Salamanca, Serv Aparato Digest, Salamanca, Spain
Delgado-Guillena, PG:
Hosp Gen Granollers, Dept Gastroenterol, Barcelona, Spain
Garcia-Rodriguez, A:
Hosp Viladecans, Dept Digest Dis, Barcelona, Spain
Guarner-Argente, C:
Univ Autonoma Barcelona, Dept Gastroenterol, Hosp Santa Creu & St Pau, Barcelona, Spain
Muriel, A:
Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Epidemiol & Salud Publ, Inst Raman Y Cajal Invest Sanitaria, Clin Biostat Unit, Madrid, Spain
de la Fuente-Briongos, E:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
de Paredes, AGG:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Parejo-Carbonell, S:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Tellez, L:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Senosiain-Lalastra, C:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Burgos-Santamaria, D:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Aicart-Ramos, M:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Munoz, BM:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Penas-Garcia, B:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Pagano, G:
Hosp del Mar, Dept Gastroenterol, Endoscopy Unit, Barcelona, Spain
Urquiza, GC:
Hosp del Mar, Dept Gastroenterol, Endoscopy Unit, Barcelona, Spain
Ferreruela, MU:
Hosp del Mar, Dept Gastroenterol, Endoscopy Unit, Barcelona, Spain
de Jorge-Turrion, MA:
Hosp Aviles, Dept Gastroenterol, Aviles, Spain
Barreiro-Alonso, E:
Hosp Aviles, Dept Gastroenterol, Aviles, Spain
Inst Invest Sanitaria Principado Asturias ISPA, Oviedo, Spain
Fraile-Lopez, M:
Hosp Aviles, Dept Gastroenterol, Aviles, Spain
Gomez-Outomuro, A:
Hosp Aviles, Dept Gastroenterol, Aviles, Spain
Altamirano, MI:
Univ Barcelona, Hosp Clin, Inst Clin Enfermedades Digest & Metabol, Gastroenterol Dept,Endoscopy Unit, Barcelona, Spain
Esteban, MN:
Univ Barcelona, Hosp Clin, Inst Clin Enfermedades Digest & Metabol, Gastroenterol Dept,Endoscopy Unit, Barcelona, Spain
Ruiz-Andreu, M:
Univ Barcelona, Hosp Clin, Inst Clin Enfermedades Digest & Metabol, Gastroenterol Dept,Endoscopy Unit, Barcelona, Spain
Arribas-Anta, J:
12 Octubre Univ Hosp, Gastroenterol Dept, Endoscopy Unit, Madrid, Spain
de Frutos, D:
Hosp Univ Puerta de Hierro, Res Inst Segovia de Arana, Gastroenterol Dept, Madrid, Spain
Herreros-de-Tejada, A:
Hosp Univ Puerta de Hierro, Res Inst Segovia de Arana, Gastroenterol Dept, Madrid, Spain
Arias-Rivera, ML:
Hosp Gen Villalba, Serv Aparato Digest, Madrid, Spain
Roldan-Fernandez, M:
Hosp Univ Salamanca, Inst Invest Biomed Salamanca, Serv Aparato Digest, Salamanca, Spain
Martin, AFM:
Hosp Univ Salamanca, Inst Invest Biomed Salamanca, Serv Aparato Digest, Salamanca, Spain
Zamora, J:
Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Epidemiol & Salud Publ, Inst Raman Y Cajal Invest Sanitaria, Clin Biostat Unit, Madrid, Spain
Vazquez-Sequeiros, E:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
Albillos, A:
Univ Alcala De Henares, Hosp Univ Ramon Y Cajal, Ctr Invest Biomed Red Area Temat Enfermedades Hep, Inst Ramon Y Cajal Invest Sanitaria,Dept Gastroen, Madrid, Spain
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