Post-ERCP Bleeding in the Era of Multiple Antiplatelet Agents.
- Author:
Hyoung Chul OH
1
;
Ihab I EL HAJJ
;
Jeffrey J EASLER
;
James WATKINS
;
Evan L FOGEL
;
Lee MCHENRY
;
Glen A LEHMAN
;
Jung Sik CHOI
;
Hyun KANG
;
Stuart SHERMAN
Author Information
- Publication Type:Original Article
- Keywords: Cholangiopancreatography; endoscopic retrograde; Hemorrhage; Platelet aggregation inhibitors
- MeSH: Aspirin; Cholangiopancreatography, Endoscopic Retrograde; Hemorrhage*; Humans; Multivariate Analysis; Platelet Aggregation Inhibitors*
- From:Gut and Liver 2018;12(2):214-218
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: This study aimed to determine the risk of post-endoscopic retrograde cholangiopancreatography (post-ERCP) bleeding among patients taking antiplatelet agents (APAs), particularly in the era of multiple APAs. METHODS: The primary outcomes were the frequency, type, and severity of ERCP-related bleeding according to the use of APAs. RESULTS: The frequencies of post-ERCP bleeding among the four different groups were 16 of 2,083 (0.8%) in the no drug group, 12 of 256 (4.7%) in the aspirin group, 3 of 48 (6.3%) in the single APA group, and 4 of 48 (8.3%) in the multiple APA group (p<0.001). In the univariate analysis, post-ERCP bleeding was associated with age, pull-type sphincterotomy, and APA and was inversely associated with balloon dilation of the biliary orifice. In the multivariate analysis, pull-type sphincterotomy (odds ratio [OR], 7.829; 95% confidence interval [CI], 1.411 to 43.453; p=0.019) and country (Korea: OR, 0.124; 95% CI, 0.042 to 0.361; p<0.001) were associated with post-ERCP bleeding. CONCLUSIONS: The frequency of post-ERCP bleeding was statistically higher in patients on any APA within 6 days prior to ERCP. However, in the multivariate analysis, APA use was not associated with post-ERCP bleeding. Until a large, adequately powered study to detect differences is performed, caution is recommended when considering invasive procedures during ERCP in patients on APAs.
