Outcomes of EUS-FNA in patients receiving antithrombotic therapy

Abstract

Background and study aims To investigate bleeding risk and thromboembolic risk in patients receiving antithrombotic therapy who underwent endoscopic ultrasound-guided fine-needls aspiration (EUS-FNA). Patients and methods A single-center retrospective study of 908 consecutive patients undergoing EUS-FNA for pancreatic and non-pancreatic lesions patients between March 2013 and March 2017 was performed. Antithrombotic management was classified into three groups: continuous, discontinuation, and heparin replacement. Results A total of 114 patients (12.6 %) were on antithrombotic drugs and 794 (84.6 %) were not. There were six cases of significant bleeding (0.7 %) four in the antithrombotic group (0.4 %) and two (0.2 %) in the non-antithrombotic group, (odds ratio, 9.59; 95 % confidence interval, 2.12 – 43.1; P = 0.006). Of the four cases in the antithrombotic group, two were on continuous treatment, one was on discontinuation treatment and one was on heparin replacement. All cases of non-significant bleeding occurred in the non-antithrombotic group (3 peri-tumoral hematomas, 1 submucosal hematoma, and 1 intraluminal bleed). The sole thromboembolic event (0.9 %) was a cerebral infarction in the antithrombotic group in a patient on thienopyridine who switched to aspirin before the procedure. Conclusions There was a slight increase in risk of bleeding in patients receiving antithrombotic therapy especially postoperative bleeding; however, there were no cases of severe bleeding was seen and only one case of cerebral infarction which occurred in a high-risk thromboembolic patients. We concluded that EUS-FNA in a safe procedure for patients on antithrombotics, even when antithrombotic therapy is not discontinued during EUS-FNA.

Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy

“…7 This finding was consistent with those of other single-center studies. 6,8 In the present study, the number of patients in the ATA group (especially in the anticoagulant group) was small. Therefore, we could not make a judgment about the differences among the antithrombotic drugs.…”

“…4 Two previous studies from Japan on EUS-FNA in patients with antithrombotic therapy found a low incidence of EUS-FNA-related bleeding in patients receiving antithrombotic therapy (0.4%-1.0%). 6,8 The bleeding event rate was low even in patients who underwent EUS-FNA while continuing antithrombotic therapy. The bleeding risk was found to increase according to the type of antithrombotic drugs (e.g., warfarin and heparin).…”

“…However, there are few reports about bleeding related to EUS-FNA in patients undergoing antithrombotic therapy. [5][6][7][8] Moreover, there is almost no available evidence on EUS-BD in patients undergoing antithrombotic therapy. As EUS-BD requires dilation and stent placement as well as puncture, it may influence the incidence of bleeding events.…”

An international, multi-institution survey on performing EUS-FNA and fine needle biopsy

“…The conclusion of the study was that EUS-FNA was a safe procedure for patients using antithrombotic agents, even when antithrombotic therapy is not discontinued during EUS-FNA. [ 52 ] A retrospective study conducted with 742 consecutive patients who underwent EUS-FNA for solid lesions compared bleeding event rates among patients not using antithrombotic agents, those discontinuing their use, those continuing treatment with aspirin or cilostazol, and those who were on replacement therapy with heparin. A low incidence of EUS-FNA-related bleeding in patients receiving antithrombotic treatment was found; the bleeding event rate was low even in patients who underwent EUS-FNA while continuing aspirin or cilostazol.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

“…The only significant differences were between patients on prophylactic low molecular weight heparin and controls [128]. In the largest study, however, no severe haemorrhage was found in patients who continued or discontinued antithrombotic therapy, and only one thromboembolic event occurred [129].…”