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KMID : 1188320180120020214
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Gut and Liver
2018 Volume.12 No. 2 p.214 ~ p.218
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Post-ERCP Bleeding in the Era of Multiple Antiplatelet Agents
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Oh Hyoung-Chul
El Hajj Ihab I.
Easler Jeffrey J.
Watkins James
Fogel Evan L.
McHenry Lee
Lehman Glen A.
Choi Jung-Sik
Kang Hyun
Sherman Stuart
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Abstract
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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.
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KEYWORD
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Cholangiopancreatography, endoscopic retrograde, Hemorrhage, Platelet aggregation inhibitors
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