Abstract
Background/Aim
Endoscopic sphincterotomy is considered high risk for post-procedure bleeding. Sphincterotomy
in patients on therapeutic anticoagulation is avoided given increased bleeding risk.
There is minimal data on the risk of post-sphincterotomy bleeding (PSB) among those
on prophylactic anticoagulation for venous thromboembolism (VTE) prophylaxis.
Methods
We performed a retrospective case control study of all inpatient endoscopic retrograde
cholangiopancreatographies (ERCPs) with a sphincterotomy at our institution between
July 2016 to February 2020. Cases were divided into two groups based on administration
of peri‑procedural pharmacologic VTE prophylaxis. The outcomes were the rates of PSB
and VTE within 30-days of the ERCP.
Results
A total of 369 inpatient ERCPs with a sphincterotomy were identified. 151 cases received
peri‑procedural pharmacologic VTE prophylaxis and 218 did not. The mean Padua score
and American Society of Anesthesiologists physical status classification were significantly
greater in the prophylaxis group. PSB was statistically similar between both groups
(3.3% vs. 5.5%, p=.32). VTE was statistically similar (0.7% vs. 0.5%, p=.79). Multivariate analysis did not reveal an association between PSB and peri‑procedural
pharmacologic VTE prophylaxis.
Conclusion
Peri-procedural pharmacologic VTE prophylaxis is not associated with increased rates
of PSB. These findings suggest that pharmacologic VTE prophylaxis can be safely continued
in those undergoing an endoscopic sphincterotomy.
Keywords
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References
- The management of antithrombotic agents for patients undergoing GI endoscopy.Gastrointest Endosc. Jan 2016; 83: 3-16https://doi.org/10.1016/j.gie.2015.09.035
- Endoscopic biliary sphincterotomy on thienopyridine therapy compared to low dose aspirin alone has similar outcomes.Minerva Gastroenterol Dietol. Sep 2019; 65: 248-250https://doi.org/10.23736/S1121-421X.19.02598-4
- Biliary-pancreatic endoscopic and surgical procedures in patients under dual antiplatelet therapy: a single-center study.Clin Endosc. Jul 2013; 46: 395-398https://doi.org/10.5946/ce.2013.46.4.395
- Safety and efficacy of minimal biliary sphincterotomy with papillary balloon dilation (m-EBS+EPBD) in patients using clopidogrel or anticoagulation.Endosc Int Open. Mar 2017; 5: E157-E164https://doi.org/10.1055/s-0042-120225
- Update on biliary endoscopy.Curr Opin Gastroenterol. May 2005; 21: 354-358
- Endoscopic sphincterotomy-induced hemorrhage: a study of risk factors and the role of epinephrine injection.Gastrointest Endosc. Dec 1995; 42: 550-554
- Complications of endoscopic biliary sphincterotomy.N Engl J Med. Sep 1996; 335: 909-918https://doi.org/10.1056/NEJM199609263351301
- Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years.Gastrointest Endosc. Jul 2009; 70: 80-88https://doi.org/10.1016/j.gie.2008.10.039
- Delayed hemorrhage following endoscopic retrograde sphincterotomy for choledocholithiasis.Dig Dis Sci. May 1996; 41: 831-834
- Major hemorrhage from endoscopic sphincterotomy: risk factor analysis.J Clin Gastroenterol. Dec 1994; 19: 283-287
- Injection treatment of hemorrhage induced by endoscopic sphincterotomy.Endoscopy. Jan 1998; 30: 37-39
- Management of clinically relevant bleeding following endoscopic sphincterotomy.Endoscopy. Feb 1994; 26: 217-221
- Do aspirin and non-steroidal anti-inflammatory drugs increase the risk of post-sphincterotomy hemorrhage–a case-control study.Clin Res Hepatol Gastroenterol. Apr 2013; 37: 171-176https://doi.org/10.1016/j.clinre.2012.04.010
- Clinically significant delayed postsphincterotomy bleeding: a twelve year single center experience.Minerva Gastroenterol Dietol. Sep 2007; 53: 215-223
- Endoscopic hemostasis in sphincterotomy-induced hemorrhage: its efficacy and safety.Endoscopy. Aug 1999; 31: 431-436https://doi.org/10.1055/s-1999-42
- Economic burden of venous thromboembolism in hospitalized patients.Pharmacotherapy. Aug 2009; 29: 943-953https://doi.org/10.1592/phco.29.8.943
- A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study.Arch Intern Med. May 1991; 151: 933-938
- Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort.Am J Med. Sep 2013; 126 (832.e13-21)https://doi.org/10.1016/j.amjmed.2013.02.024
- Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study.Arch Intern Med. Mar 1998; 158: 585-593https://doi.org/10.1001/archinte.158.6.585
- The epidemiology of venous thromboembolism.Circulation. Jun 2003; 107: I4-I8https://doi.org/10.1161/01.CIR.0000078468.11849.66
- Incidence of venous thromboembolism in hospitalized patients vs community residents.Mayo Clin Proc. Nov 2001; 76: 1102-1110https://doi.org/10.4065/76.11.1102
- Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy.Chest. Sep 2004; 126: 338S-400Shttps://doi.org/10.1378/chest.126.3_suppl.338S
- Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism : a cohort study.JAMA Intern Med. Oct 2014; 174: 1577-1584https://doi.org/10.1001/jamainternmed.2014.3384
- American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients.Blood Adv. 2018; 11 (2): 3198-3225https://doi.org/10.1182/bloodadvances.2018022954
- Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies.Arch Intern Med. Sep 2002; 162: 1833-1840
- Preoperative or postoperative start of prophylaxis for venous thromboembolism with low-molecular-weight heparin in elective hip surgery?.Arch Intern Med. Jul 2002; 162: 1451-1456
- Risk factors and pharmacologic prophylaxis for venous thromboembolism in elective spine surgery.Spine J. 2018; 06 (18): 970-978https://doi.org/10.1016/j.spinee.2017.10.013
- The rate of bleeding complications after pharmacologic deep venous thrombosis prophylaxis: a systematic review of 33 randomized controlled trials.Arch Surg. Aug 2006; 141 (790-7; discussion): 797-799https://doi.org/10.1001/archsurg.141.8.790
- The impact of pharmacological thromboprophylaxis and disease-stage on postoperative bleeding following colorectal cancer surgery.World J Surg Oncol. Jun 2019; 17: 110https://doi.org/10.1186/s12957-019-1653-1
- Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines.Chest. Feb 2012; 141: e278S-e325Shttps://doi.org/10.1378/chest.11-2404
- A lexicon for endoscopic adverse events: report of an ASGE workshop.Gastrointest Endosc. Mar 2010; 71: 446-454https://doi.org/10.1016/j.gie.2009.10.027
- Adverse events associated with ERCP.Gastrointest Endosc. Jan 2017; 85: 32-47https://doi.org/10.1016/j.gie.2016.06.051
- A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score.J Thromb Haemost. Nov 2010; 8: 2450-2457https://doi.org/10.1111/j.1538-7836.2010.04044.x
- Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit assessment of thromboembolic risk and prophylaxis for medical patients in SwitzErland (ESTIMATE).Thromb Haemost. Mar 2014; 111: 531-538https://doi.org/10.1160/TH13-05-0427
- Predictive and associative models to identify hospitalized medical patients at risk for VTE.Chest. Sep 2011; 140: 706-714https://doi.org/10.1378/chest.10-1944
- Gender differences in the administration of prophylaxis to prevent deep venous thrombosis.Thromb Haemost. Feb 2005; 93: 284-288https://doi.org/10.1160/TH04-08-0513
- Gender bias in cardiovascular testing persists after adjustment for presenting characteristics and cardiac risk.Acad Emerg Med. Jul 2007; 14: 599-605https://doi.org/10.1197/j.aem.2007.03.1355
Article info
Publication history
Published online: April 22, 2021
Accepted:
March 29,
2021
Received:
February 11,
2021
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
