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Endoscopy-Related Bleeding and Thromboembolic Events in Patients on Direct Oral Anticoagulants or Vitamin K Antagonists

2020; Elsevier BV; Volume: 20; Issue: 3 Linguagem: Inglês

10.1016/j.cgh.2020.11.037

1542-7714

Enrique Rodríguez de Santiago, Rubén Sánchez-Aldehuelo, Faust Riu, Carlos Rodríguez Escaja, Glòria Fernández‐Esparrach, Ángel Cañete-Ruiz, Carlos Ferre‐Aracil, Daniel Pérez-Corte, Raquel Ríos León, Héctor Miguel Marcos-Prieto, Pedro Delgado‐Guillena, Ana García‐Rodríguez, Carlos Guarner‐Argente, Alfonso Muriel, Elsa de la Fuente-Briongos, Ana García García de Paredes, Sofía Parejo-Carbonell, Luís Téllez, Carla Senosiaín Lalastra, Diego Burgos‐Santamaría, Marta Aicart‐Ramos, Beatriz Muñoz, Beatriz Peñas-García, Giulia Pagano, Gemma Casals Urquiza, Miguel Urpí, Miguel Ángel de Jorge Turrión, Eva Barreiro Alonso, Miguel Fraile López, Ana Gómez‐Outomuro, María Isabel Altamirano, M Núñez Esteban, Mireia Ruiz-Andreu, Julia Arribas-Anta, Diego de Frutos, Alberto Herreros de Tejada, María Luisa Arias-Rivera, Marta Roldán-Fernández, Ángel F. Marcos Martín, Javier Zamora, Enrique Vázquez-Sequeiros, Agustı́n Albillos, José Ramón Foruny Olcina, Aida Argüelles Longoria, Carmen María González González, Juan Ángel González-Martín, Eduardo Tavío-Hernádez, Alba Martínez-Sánchez, Sergio López-Durán, Francisco Mesonero-Gismero, Pablo Pérez Riveras, Ana García Cid, Marta Rodríguez-Carrasco, Teresa Álvarez-Nava Torrego, David Esteban, María López‐Cerón,

Atrial Fibrillation Management and Outcomes

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, endoscopy-related 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. 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. 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. 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). In a prospective study of patients on DOACs or VKAs undergoing elective endoscopy, endoscopy-related 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.