Author/Authors :
Yamaguchi, Daisuke Department of Gastroenterology - National Hospital Organization Ureshino Medical Center, Ureshino, Japan , Tominaga, Naoyuki Department of Gastroenterology - Saga-Ken Medical Centre Koseikan, Japan , Miyahara, Koichi Department of Internal Medicine, Karatsu Red Cross Hospital, Karatsu, Japan , Tsuruoka, Nanae Division of Gastroenterology - Department of Internal Medicine - Faculty of Medicine - Saga University, Japan , Sakata, Yasuhisa Division of Gastroenterology - Department of Internal Medicine - Faculty of Medicine - Saga University, Japan , Takeuchi, Yuki Department of Gastroenterology - National Hospital Organization Ureshino Medical Center, Ureshino, Japan , Matsunaga, Takuya Department of Gastroenterology - Saga-Ken Medical Centre Koseikan, Japan , Hidaka, Hidenori Department of Internal Medicine, Karatsu Red Cross Hospital, Karatsu, Japan , Akutagawa, Takashi Division of Gastroenterology - Department of Internal Medicine - Faculty of Medicine - Saga University, Japan , Noda, Takahiro Department of Internal Medicine, Karatsu Red Cross Hospital, Karatsu, Japan , Ogata, Shinichi Department of Gastroenterology - Saga-Ken Medical Centre Koseikan, Japan , Tsunada, Seiji Department of Gastroenterology - National Hospital Organization Ureshino Medical Center, Ureshino, Japan , Esaki, Motohiro Division of Gastroenterology - Department of Internal Medicine - Faculty of Medicine - Saga University, Japan
Abstract :
Background and Aims
The present study aimed to clarify the safety and efficacy of the noncessation method of antithrombotic agents after emergency endoscopic hemostasis in patients with nonvariceal upper gastrointestinal bleeding (UGIB).
Methods
In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for nonvariceal UGIB in patients taking antithrombotic agents and resumed the medications without a cessation period (group A). The clinical characteristics, types of antithrombotic agents, UGIB etiology, treatment outcome, and adverse events were evaluated. We used propensity score matching to compare treatment outcomes and adverse events with our previous cohort (group B) in whom antithrombotic agents were transiently discontinued after emergency endoscopic hemostasis.
Results
Forty-three consecutive patients were prospectively enrolled. The main antithrombotic agents were low-dose aspirin and direct oral anticoagulants; 11 patients (25.6%) were taking multiple antithrombotics. Peptic ulcers were the main cause of bleeding (95.4%). Endoscopic hemostasis was successful in all patients and the incidence of rebleeding within a month was 7.0%. Propensity score matching created 40 matched pairs. Endoscopic hemostasis was performed by soft coagulation significantly more frequently in group A than in group B (97.5% versus 60.0%, P < 0.001). Neither the rebleeding rate within a month nor thromboembolic event rate was different between the two groups. However, the mean duration of hospitalization was significantly shorter in group A than in group B (8.6 ± 5.2 d versus 14.4 ± 7.1 d, P < 0.001).
Conclusions
Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for nonvariceal UGIB.
