Post-ERCP Bleeding in the Era of Multiple Antiplatelet Agents

• Published in: Gut and liver Vol. 12; no. 2; pp. 214 - 218
• Main Authors: Hyoung-chul Oh, Ihab I. El Hajj, Jeffrey J. Easler, James Watkins, Evan L. Fogel, Lee Mchenry, Glen A. Lehman, Jung Sik Choi, Hyun Kang, Stuart Sherman
• Format: Journal Article
• Language: Korean
• Published: 대한소화기내시경학회 30.03.2018
• Subjects: Cholangiopancreatography; endoscopic retrograde; Hemorrhage; Platelet aggregation inhibitors
• ISSN: 1976-2283

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. (Gut Liver 2018;12:214-218)