Bleeding Risk Related to Upper Gastrointestinal Endoscopic Biopsy in Patients Receiving Antithrombotic Therapy: A Multicenter Prospective Observational Study

Takafumi Yuki, MD, PhD; Shunji Ishihara, MD, PhD; Kazuo Yashima, MD, PhD; Koichiro Kawaguchi, MD, PhD; Hirofumi Fujishiro, MD, PhD; Youichi Miyaoka, MD, PhD; Mika Yuki, MD, PhD; Yoshinori Kushiyama, MD, PhD; Akiko Yasugi, MD, PhD; Michiko Shabana, MD, PhD; Koichirou Furuta, MD, PhD; Kiwamu Tanaka, MD, PhD; Masaharu Koda, MD, PhD; Tetsuro Hamamoto, MD, PhD; Yuichiro Sasaki, MD, PhD; Hisao Tanaka, MD, PhD; Teiji Yoshimura, MD; Yoshikazu Murawaki, MD, PhD; Hajime Isomoto, MD, PhD; Yoshikazu Kinoshita, MD, PhD

doi:10.1016/j.curtheres.2017.03.006

Current Therapeutic Research (Jan 2017)

Bleeding Risk Related to Upper Gastrointestinal Endoscopic Biopsy in Patients Receiving Antithrombotic Therapy: A Multicenter Prospective Observational Study

Takafumi Yuki, MD, PhD,
Shunji Ishihara, MD, PhD,
Kazuo Yashima, MD, PhD,
Koichiro Kawaguchi, MD, PhD,
Hirofumi Fujishiro, MD, PhD,
Youichi Miyaoka, MD, PhD,
Mika Yuki, MD, PhD,
Yoshinori Kushiyama, MD, PhD,
Akiko Yasugi, MD, PhD,
Michiko Shabana, MD, PhD,
Koichirou Furuta, MD, PhD,
Kiwamu Tanaka, MD, PhD,
Masaharu Koda, MD, PhD,
Tetsuro Hamamoto, MD, PhD,
Yuichiro Sasaki, MD, PhD,
Hisao Tanaka, MD, PhD,
Teiji Yoshimura, MD,
Yoshikazu Murawaki, MD, PhD,
Hajime Isomoto, MD, PhD,
Yoshikazu Kinoshita, MD, PhD

Affiliations

Takafumi Yuki, MD, PhD: Gastrointestinal Endoscopy, Shimane University Hospital, Izumo, Japan
Shunji Ishihara, MD, PhD: Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan
Kazuo Yashima, MD, PhD: Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Yonago, Japan
Koichiro Kawaguchi, MD, PhD: Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Yonago, Japan
Hirofumi Fujishiro, MD, PhD: Division of Gastroenterology, Shimane Prefectural Central Hospital, Izumo, Japan
Youichi Miyaoka, MD, PhD: Division of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Japan
Mika Yuki, MD, PhD: Division of Internal Medicine, Izumo-City General Medical Center, Izumo, Japan
Yoshinori Kushiyama, MD, PhD: Division of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
Akiko Yasugi, MD, PhD: Division of Gastroenterology, National Hospital Organization Hamada Medical Center, Hamada, Japan
Michiko Shabana, MD, PhD: Division of Gastroenterology, Sanin Rosai Hospital, Yonago, Japan
Koichirou Furuta, MD, PhD: Division of Gastroenterology, Masuda Red Cross Hospital, Masuda, Japan
Kiwamu Tanaka, MD, PhD: Division of Gastroenterology, Tottori Prefectural Central Hospital, Tottori, Japan
Masaharu Koda, MD, PhD: Division of Gastroenterology, Yonago Medical Center, Yonago, Japan
Tetsuro Hamamoto, MD, PhD: Division of Gastroenterology, Hakuai Hospital, Yonago, Japan
Yuichiro Sasaki, MD, PhD: Division of Gastroenterology, Tottoriken Saiseikai Sakaiminato General Hospital, Sakaiminato, Japan
Hisao Tanaka, MD, PhD: Division of Gastroenterology, Tottori Red Cross Hospital, Tottori, Japan
Teiji Yoshimura, MD: Division of Gastroenterology, Matsue City Hospital, Matsue, Japan
Yoshikazu Murawaki, MD, PhD: Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Yonago, Japan
Hajime Isomoto, MD, PhD: Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Yonago, Japan
Yoshikazu Kinoshita, MD, PhD: Department of Internal Medicine II, Shimane University Faculty of Medicine, Izumo, Japan

DOI: https://doi.org/10.1016/j.curtheres.2017.03.006
Journal volume & issue: Vol. 84, no. C
pp. 32 – 36

Abstract

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Background: Although antithrombotic agents are widely used for cardiac and cerebrovascular disease prevention, they increase the risk of gastrointestinal (GI) bleeding. Objective: To examine GI bleeding risk in association with an esophagogastroduodenoscopy (EGD) biopsy performed in patients without cessation of antithrombotic therapy. Methods: This study was prospectively conducted at 14 centers. EGD biopsies were performed in patients receiving antithrombotic agents without cessation, as well as age- and sex-matched controls not receiving antithrombotic therapy. Patients treated with warfarin before the biopsy had a prothrombin time-international normalized ratio level <3.0. The proportion of GI bleeding events was compared between the groups. Results: The patient group (n = 277) underwent a total of 560 biopsies while continuing antithrombotic therapy, of whom 24 were receiving multiple antiplatelet drugs, and 9 were receiving both antiplatelet and anticoagulant agents. The control patients (n = 263) underwent 557 biopsies. The upper-GI bleeding rate within 30 days after the EGD biopsy did not increase in patients without cessation of antithrombotic treatment, regardless of receiving single or multiple antithrombotic agents. Conclusions: We found no significant increase in upper-GI bleeding risk following an EGD biopsy in patients taking antithrombotic agents, suggesting its safety without the need for antithrombotic treatment interruption.

Published in Current Therapeutic Research

ISSN: 0011-393X (Print); 1879-0313 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Therapeutics. Pharmacology
Website: http://www.journals.elsevier.com/current-therapeutic-research/

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