Questionnaire-Based Survey on Gastrointestinal Bleeding and Management of Antithrombotic Agents during Endoscopy Among Asian Countries

Abstract

Objective: Guidelines on the management of antithrombotic therapy for endoscopic procedures vary among countries. Differences in the management of antithrombotic agents for endoscopic procedures between Western and Eastern countries have already been reported. However, no study has investigated the differences among Asian countries. The aim of this study was to examine the differences in the etiology of gastrointestinal bleeding and management of antithrombotic agents during endoscopic procedures between Japan and other Asian countries (OAC). Methods: Questionnaires regarding gastrointestinal bleeding in clinical practice and management of antithrombotic agents during endoscopy were distributed to members of the International Gastroenterology Consensus Symposium Study Group. We analyzed the questionnaire answers and compared the results between Japan and OAC. Results: The cause of and treatment methods for gastrointestinal bleeding differed between Japan and OAC. In Japan, the trend was to continue drugs at the time of biopsy and endoscopic therapy. Even in cases of discontinuation, the drug withdrawal period was as short as <3 days. Thrombotic complications caused by the withdrawal of antithrombotic agents were observed more frequently in Japan (34.78%) than in OAC (22.46%; p = 0.016). Conclusion: Due to differences in guidelines and complications associated with discontinuation of drugs, the antithrombotic withdrawal period in Japan tended to be shorter than that in OAC.

Decline incidence in upper gastrointestinal bleeding in several recent years: data of the Japan claims database of 13 million accumulated patients

“…The incidence of upper GI bleeding was affected by several factors, including peptic ulcers, gastroesophageal varices, GERD, Mallory-Weiss tears, and prescription of antithrombotic agents and NSAIDs, as previously demonstrated. (1,7,(10)(11)(12)(13)(17)(18)(19) The decrease in the incidence of upper GI bleeding synchronized with the diminished incidence of peptic ulcers from 2009 to 2014, as indicated in Fig. 1B.…”

“…Introduction U pper gastrointestinal (GI) bleeding is a serious and lethal condition especially in older patients, and endoscopic hemostasis and/or radiological intervention are widely applicable therapeutic approaches. (1)(2)(3)(4)(5)(6)(7)(8) Upper GI bleeding can be induced by lesions of the esophagus, stomach, and duodenum, including gastroduodenal ulcers induced by Helicobacter pylori (H. pylori) infection, nonsteroidal anti-inflammatory drugs (NSAIDs), and antithrombotic agents; Mallory-Weiss tears; and gastroesophageal varices. (1,2,(9)(10)(11)(12) The Japan Medical Data Center (JMDC) claims database is a real-world database in Japan that has been available for research purposes since 2005.…”

Correlation of Barrett's esophagus with colorectal polyps in Japanese patients: A retrospective chart review

“…Several factors might be related to an increased or decreased risk of Barrett's esophagus and colorectal neoplasms, including the bile acid level, 37-39 gastrin level, 29,40,41 genetic factors, [42][43][44] and treatment with nonsteroidal anti-inflammatory drugs and/or aspirin. 29,[45][46][47][48] The present chart review did not evaluate these factors. There were also several other limitations in the present study.…”

“…Several factors might be related to an increased or decreased risk of Barrett's esophagus and colorectal neoplasms, including the bile acid level, gastrin level, genetic factors, and treatment with nonsteroidal anti‐inflammatory drugs and/or aspirin …”

To Do or Not to Do: Whether to Hold or Continue Antithrombotics before Endoscopy

“…6 Another survey from Japan reported that endoscopists were more likely to discontinue anticoagulants compared with antiplatelets. 7 In this survey, the respondents were given a certain situation and were asked if they would perform the endoscopic procedure if the patient was taking antithrombotics. For example, the respondents were asked if they would perform a biopsy in patients with an active gastric ulcer if the patient was taking aspirin.…”