Predictive Factors for Post-Ercp Bleeding. Influence of Direct Oral Anticoagulants

Castañera, Ernesto Parras; López, Pelayo Rodríguez; Delgado, Alberto Álvarez; Núñez, Fernando Muñoz; Martínez, Fernando Geijo; Guardado, A Velasco

doi:10.17235/reed.2020.7547/2020

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…In contrast to LMWH, DOACs may not have a readily available reversal agent, which may be a factor limiting their use in children. Furthermore, use of DOACs has been shown to significantly increase the risk of bleeding in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Splenic Vein Thrombosis Secondary to Acute Pancreatitis with Oral Anticoagulants: A Pediatric Case Series

et al. 2022

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Case series Patients: Female, 13-year-old • Female, 9-year-old Final Diagnosis: Pediatric acute recurrent pancreatitis • splanchnic venous thrombosis involving the splenic vein Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Pediatrics and Neonatology Objective: Unusual clinical course Background: Splanchnic venous thrombosis is a known complication of pancreatitis in children and can involve the splenic, portal, or superior mesenteric veins, either in isolation or in combination. However, diagnosis and management of thrombosis following pancreatitis remains controversial, especially regarding the use of anticoagulants for management. Here, we present the cases of 2 children who developed splanchnic vein thrombosis involving the splenic vein during attacks of pancreatitis and who were successfully treated with direct oral anticoagulants. Case Reports: Case 1: A 13-year-old girl presented with a second attack of acute pancreatitis. She developed a non-occlusive splenic vein thrombosis diagnosed by CT scan on the sixth day of hospitalization. Injectable low-molecular-weight heparin was started during hospitalization and switched to oral rivaroxaban at discharge. Imaging at follow-up showed resolution of thrombosis. Case 2: A 9-year-old girl with history of acute recurrent pancreatitis presented with a third attack of acute pancreatitis. An occlusive splenic vein thrombosis with extension into the portal vein and superior mesenteric vein and necrotizing pancreatitis was seen on CT scan on the third day of hospitalization. Low-molecular-weight heparin was initiated during hospitalization and was switched to oral rivaroxaban at discharge. Imaging at follow-up demonstrated nearly complete resolution of the extensive thrombosis. Conclusions: Splanchnic venous thrombosis remains a rare complication of pediatric pancreatitis. Anticoagulant use in patients with these complications remains controversial. Direct oral anticoagulants are as safe and effective as low-molecular-weight heparin and should be considered for use in children instead of low-molecular-weight heparin due to its advantages, including the availability of enteral forms of administration.

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Section: Discussionmentioning

confidence: 99%

Successful Treatment of Splenic Vein Thrombosis Secondary to Acute Pancreatitis with Oral Anticoagulants: A Pediatric Case Series

et al. 2022

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“…In patients who require secondary prophylaxis for cardiovascular disease, aspirin can be administered peri-procedurally, given its lower risk of PEB compared with other APAs or multiple APAs. 52 With regards to anticoagulation, a retrospective study by Parras Castañera et al 53 showed that patients who underwent ERCP while on direct oral anticoagulants were 3.6 (95% CI 1.0–12.8) times more likely to develop PEB compared to those on low molecular weight heparin or acenocoumarin.…”

Section: Bleedingmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management

Lim

Khor

2023

Clin Endosc

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Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

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“…5 Bleeding post ERCP is a major concern for healthcare professionals despite its low incidence as it can lead to major complications in patients who often have prior comorbidities. 6 A number of risk factors can predispose a patient to bleeding after undergoing an ERCP including use of anticoagulants whether or not the physician performed a sphincterotomy, 7 presence of liver cirrhosis, 4 age 5 and a number of others. As such, it is the goal of all physicians performing the procedure to minimize the risk of hemorrhage in the often already at risk population undergoing the treatment.…”

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confidence: 99%

Frequency of Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Complications

Razzak¹,

Raza²

2023

J. Bahria Uni. Med. Dent. Coll.

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Objective: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a highly technical procedure that carries somerisks associated with it. It consolidates the utilization of an endoscope with X-ray to look at the biliary and pancreaticchannels with the ability to intervene when indicated to address problems identified during surgery. This study aimed todetermine the frequencyStudy Design & Setting: Cross-sectional study design at Dow Hospital Karachi.Methodology: The patients with the age ranging from 18 to 60 years who had endoscopies were taken from July 2020 toFebruary 2021. All the pregnant patients and those who were unwilling to participate in the study were excluded from thestudy. The data were collected from the patients and they were kept under observation for 4 – 6 hours after ERCP to monitorthe development of an immediate complication. The findings were recorded only at 48 hours of the procedure.Results: The age of the participants was 37±12 years on average. The complications were recorded with pancreatitis at36% followed by 34.5% bleeding and 29% perforation. 92% of the procedures were successful.Conclusions: In conclusion, while ERCP is generally considered a safe and effective procedure, it is not without risks.The most common complications of ERCP are pancreatitis, bleeding, and perforation

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Predictive Factors for Post-Ercp Bleeding. Influence of Direct Oral Anticoagulants

Cited by 3 publications

References 24 publications

Successful Treatment of Splenic Vein Thrombosis Secondary to Acute Pancreatitis with Oral Anticoagulants: A Pediatric Case Series

Successful Treatment of Splenic Vein Thrombosis Secondary to Acute Pancreatitis with Oral Anticoagulants: A Pediatric Case Series

Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management

Frequency of Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) Complications

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