Risk of Bleeding on Anti-Platelet and Anti-coagulant Therapy Undergoing Elective Endoscopic Procedures

Abstract

Introduction: The most common site for significant bleeding in patients receiving oral anticoagulation therapy is the gastro-intestinal (GI) tract. (Choudari et al. GUT 1994) Acute GI hemorrhage in patients on anticoagulant or antiplatelet agents could results in a life-threatening situation. The GI safety profile of new oral anticoagulants is not yet entirely understood. We aim to assess the impact of anticoagulation and antiplatelet therapy continuation during the peri-procedural period on risk of bleeding or hospitalization in patients undergoing elective endoscopic procedures at Sanford Health in Fargo. Methods: IRB approval was obtained from University of North Dakota and Sanford health. Clinical database from Sanford medical center was searched by a data extraction expert with appropriate ICD-9 codes. 200 medical charts were manually reviewed from 6/23/2015- 11/5/2015; 141 patients were included in the final data analysis. Clinical endpoints included major bleeding during the procedure and bleeding requiring hospitalization or endoscopic intervention. Results: Out of 141 patients 56.7% were males and 43.3% were females, Average age was 67.7 ± 9.3 years in males and 66.9 ± 9.8 years in females (p=0.60). 67.3 % of patients (95 patients) had polyps and 43.3 % of patients (61 patients) had diverticulosis. 50 patients underwent polypectomies while on therapeutic anticoagulation and 56 patients were on aspirin. Median HAS-BLEDscore was 1 (range: 0-3). None of the patients developed the primary endpoints of major bleeding, bleeding requiring hospitalization or endoscopic intervention. Conclusion: Despite the fact that 52% (50/95) of patients undergoing polypectomy were on new oral anticoagulant agents or therapeutic doses of Coumadin there was no occurrence of major bleeding, bleeding requiring hospitalization and endoscopic intervention for bleeding. Our limited dataset shows results congruent with other studies done prior (Gerson et al, Am J Gastroenterol 2000; 95:1717-24.) regarding safety of screening colonoscopies with biopsies in patients on therapeutic Coumadin. Furthermore, our study provides preliminary evidence that performing screening colonoscopies with biopsies in patients on new oral anticoagulants is likely safe. Further larger studies are required to confirm our findings, especially in regard to safety when patients are on new oral anticoagulants.