Gut Liver.  2018 Mar;12(2):214-218. 10.5009/gnl17204.

Post-ERCP Bleeding in the Era of Multiple Antiplatelet Agents

• Oh HC
• El Hajj II
• Easler JJ
• Watkins J
• Fogel EL
• McHenry L
• Lehman GA
• Choi JS
• Kang H
• Sherman S

• KMID: 2429077
• DOI: http://doi.org/10.5009/gnl17204

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.

Keyword

Cholangiopancreatography; endoscopic retrograde; Hemorrhage; Platelet aggregation inhibitors

MeSH Terms

Aspirin
Cholangiopancreatography, Endoscopic Retrograde
Hemorrhage*
Humans
Multivariate Analysis
Platelet Aggregation Inhibitors*
Aspirin
Platelet Aggregation Inhibitors