Post-ERCP bleeding in the era of multiple antiplatelet agents

Hyoung Chul Oh, Ihab I. El Hajj, Jeffrey J. Easler, James Watkins, Evan Fogel, Lee McHenry, Glen Lehman, Jung Sik Choi, Hyun Kang, Stuart Sherman

Research output: Contribution to journalArticle

1 Citation (Scopus)

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

Original languageEnglish (US)
Pages (from-to)214-218
Number of pages5
JournalGut and Liver
Volume12
Issue number2
DOIs
StatePublished - Mar 1 2018

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Endoscopic Retrograde Cholangiopancreatography
Platelet Aggregation Inhibitors
Hemorrhage
Multivariate Analysis
Odds Ratio
Confidence Intervals
Korea
Aspirin
Dilatation
Liver

Keywords

  • Cholangiopancreatography
  • Endoscopic retrograde
  • Hemorrhage
  • Platelet aggregation inhibitors

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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Post-ERCP bleeding in the era of multiple antiplatelet agents. / Oh, Hyoung Chul; El Hajj, Ihab I.; Easler, Jeffrey J.; Watkins, James; Fogel, Evan; McHenry, Lee; Lehman, Glen; Choi, Jung Sik; Kang, Hyun; Sherman, Stuart.

In: Gut and Liver, Vol. 12, No. 2, 01.03.2018, p. 214-218.

Research output: Contribution to journalArticle

Oh, HC, El Hajj, II, Easler, JJ, Watkins, J, Fogel, E, McHenry, L, Lehman, G, Choi, JS, Kang, H & Sherman, S 2018, 'Post-ERCP bleeding in the era of multiple antiplatelet agents', Gut and Liver, vol. 12, no. 2, pp. 214-218. https://doi.org/10.5009/gnl17204
Oh, Hyoung Chul ; El Hajj, Ihab I. ; Easler, Jeffrey J. ; Watkins, James ; Fogel, Evan ; McHenry, Lee ; Lehman, Glen ; Choi, Jung Sik ; Kang, Hyun ; Sherman, Stuart. / Post-ERCP bleeding in the era of multiple antiplatelet agents. In: Gut and Liver. 2018 ; Vol. 12, No. 2. pp. 214-218.
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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. (Gut Liver 2018;12:214-218).",
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AU - Oh, Hyoung Chul

AU - El Hajj, Ihab I.

AU - Easler, Jeffrey J.

AU - Watkins, James

AU - Fogel, Evan

AU - McHenry, Lee

AU - Lehman, Glen

AU - Choi, Jung Sik

AU - Kang, Hyun

AU - Sherman, Stuart

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N2 - 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).

AB - 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).

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