EUS-Guided Biliary Drainage: Should Antiplatelet Agents and Anticoagulants Be Stopped?

EUS-Guided Biliary Drainage: Should Antiplatelet Agents and Anticoagulants Be Stopped?

Vanessa M. Shami, MD, FASGE, reviewing Ogura T, et al. Gastrointest Endosc 2020 Apr 22.

Gastroenterologists are seeing an increasing number of patients taking antiplatelet agents and/or anticoagulants (APs/ACs). Discontinuation of these agents prior to therapeutic procedures is common practice; however, this comes at the expense of potential thromboembolic events. To date, there have been no studies addressing this question in patients undergoing EUS-guided biliary drainage (EUS-BD). This retrospective comparative study aimed to evaluate whether there was an increased incidence of bleeding events in individuals who underwent EUS-BD while continuing AP/AC treatment.

Forty-one patients in the AP/AC group who underwent EUS-BD were compared to 154 patients who underwent the procedure after discontinuing AP/AC therapy (control group) between May 2015 and August 2019. The overall bleeding rate and adverse events did not differ between the groups. The use of antiplatelets or anticoagulants was not significantly associated with bleeding (odds ratio, 2.96; 95% confidence interval, 0.56-14.0; P=.18), according to logistic regression analysis. However, a procedure time of greater than 20 minutes was an independent risk factor associated with bleeding.

Vanessa M. Shami, MD, FASGE

COMMENT

While this study demonstrates no difference in bleeding in patients who underwent EUS-BD and continued or discontinued antiplatelet and/or anticoagulation agents, a randomized prospective trial is needed. A similar conclusion would lessen the endoscopic dilemma of discontinuing APs/ACs, especially in those patients who are at high risk of thromboembolic events.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Ogura T, Nishioka N, Ueno S, et al. Antiplatelet and/or anticoagulant treatment does not increase hemorrhagic adverse events during EUS-guided biliary drainage. Gastrointest Endosc 2020 Apr 22. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.04.038)

Nach oben scrollen