Clin Endosc.  2013 Jul;46(4):395-398.

Biliary-Pancreatic Endoscopic and Surgical Procedures in Patients under Dual Antiplatelet Therapy: A Single-Center Study

Affiliations
  • 1Department of Gastroenterology, Pforzheim Hospital, Pforzheim, Germany. abdelsamie@ngi.de
  • 2Department of Surgery, Pforzheim Hospital, Pforzheim, Germany.

Abstract

BACKGROUND/AIMS
Dual antiplatelet therapy has to be used for at least 1 month after placement of bare metal coronary stents and for a minimum of 1 year after placement of drug eluting stents. Because of the higher risk of bleeding, guidelines strongly recommend to delay elective surgery until dual antiplatelet therapy is ended. However, no data are available regarding the bleeding risk in patients on combined aspirin/clopidogrel therapy undergoing surgical or high-risk endoscopic procedures.
METHODS
We retrospectively analyzed the medical reports of patients on dual antiplatelet therapy, the patients who had to undergo emergency biliary-pancreatic surgery or endoscopic retrograde cholangiography with endoscopic sphincterotomy while in our unit between January 2009 and July 2012.
RESULTS
In our series, biliary-pancreatic surgical and endoscopic procedures were safely performed in 11 consecutive patients on dual antiplatelet therapy with no evidence of bleeding.
CONCLUSIONS
In emergency, surgical and high risk endoscopic procedures may be performed in patients on dual antiplatelet therapy.

Keyword

Dual antiplatelet therapy; Sphincterotomy, endoscopic; General surgery

MeSH Terms

Cholangiography
Drug-Eluting Stents
Emergencies
Hemorrhage
Humans
Retrospective Studies
Sphincterotomy, Endoscopic
Stents

Reference

1. Joyce AM, Kochman ML. Update on biliary endoscopy. Curr Opin Gastroenterol. 2005; 21:354–358. PMID: 15818158.
Article
2. Ferreira LE, Baron TH. Post-sphincterotomy bleeding: who, what, when, and how. Am J Gastroenterol. 2007; 102:2850–2858. PMID: 18042116.
Article
3. Veitch AM, Baglin TP, Gershlick AH, et al. Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut. 2008; 57:1322–1329. PMID: 18469092.
Article
4. ASGE Standards of Practice Committee. Anderson MA, Ben-Menachem T, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009; 70:1060–1070. PMID: 19889407.
Article
5. King SB 3rd, Smith SC Jr, Hirshfeld JW Jr, et al. 2007 Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Circulation. 2008; 117:261–295. PMID: 18079354.
6. Airoldi F, Colombo A, Morici N, et al. Incidence and predictors of drug-eluting stent thrombosis during and after discontinuation of thienopyridine treatment. Circulation. 2007; 116:745–754. PMID: 17664375.
Article
7. Abraham NS, Hlatky MA, Antman EM, et al. ACCF/ACG/AHA 2010 expert consensus document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Am J Gastroenterol. 2010; 105:2533–2549. PMID: 21131924.
8. Chernoguz A, Telem DA, Chu E, Ozao-Choy J, Tammaro Y, Divino CM. Cessation of clopidogrel before major abdominal procedures. Arch Surg. 2011; 146:334–339. PMID: 21422366.
Article
9. Quante M, Benckert C, Thelen A, Kaisers U, Jonas S. Major abdominal surgery with continued dual antiplatelet therapy. Arch Surg. 2011; 146:1334–1335. PMID: 22106331.
Article
10. Spieker H, Benckert C, Quante M, et al. Successful liver transplantation with continued dual antiplatelet therapy. Ann Transplant. 2012; 17:127–130. PMID: 22743731.
11. Ernst A, Eberhardt R, Wahidi M, Becker HD, Herth FJ. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest. 2006; 129:734–737. PMID: 16537875.
Article
12. Feagins LA, Uddin FS, Davila RE, Harford WV, Spechler SJ. The rate of post-polypectomy bleeding for patients on uninterrupted clopidogrel therapy during elective colonoscopy is acceptably low. Dig Dis Sci. 2011; 56:2631–2638. PMID: 21455672.
Article
13. Singh M, Mehta N, Murthy UK, Kaul V, Arif A, Newman N. Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy. Gastrointest Endosc. 2010; 71:998–1005. PMID: 20226452.
Article
14. Hussain N, Alsulaiman R, Burtin P, et al. The safety of endoscopic sphincterotomy in patients receiving antiplatelet agents: a case-control study. Aliment Pharmacol Ther. 2007; 25:579–584. PMID: 17305758.
15. Boustière C, Veitch A, Vanbiervliet G, et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2011; 43:445–461. PMID: 21547880.
Article
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