Safety and Efficacy of the Noncessation Method of Antithrombotic Agents after Emergency Endoscopic Hemostasis in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study

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.

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Safety and Efficacy of the Non-Cessation Method of Antithrombotic Agents After Emergency Endoscopic Hemostasis in Patients with Non-Variceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study

10.21203/rs.3.rs-48832/v1 ◽

2020 ◽

Author(s):

Daisuke Yamaguchi ◽

Naoyuki Tominaga ◽

Koichi Miyahara ◽

Nanae Tsuruoka ◽

Yasuhisa Sakata ◽

...

Keyword(s):

Treatment Outcome ◽

Pilot Study ◽

Propensity Score ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

Antithrombotic Agents ◽

Safety And Efficacy ◽

Group A ◽

Group B ◽

Upper Gastrointestinal

Abstract Background and Aims The present study aimed to clarify the safety and efficacy of the non-cessation method of antithrombotic agents after emergency endoscopic hemostasis in Japanese patients with non-variceal upper gastrointestinal bleeding (UGIB). Methods In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for non-variceal 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 outcome 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 group B (97.5% vs. 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 group B (8.6 ± 5.2 d vs. 14.4 ± 7.1 d, P < 0.001). Conclusions Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for non-variceal UGIB.

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Efficacy of a novel hemostatic adhesive powder in patients with refractory upper gastrointestinal bleeding: a pilot study

Endoscopy ◽

10.1055/a-0809-5276 ◽

2019 ◽

Vol 51 (05) ◽

pp. 458-462 ◽

Cited By ~ 1

Author(s):

Jin-Seok Park ◽

Byung Wook Bang ◽

Su Jin Hong ◽

Eunhye Lee ◽

Kye Sook Kwon ◽

...

Keyword(s):

Pilot Study ◽

Gastrointestinal Bleeding ◽

Success Rate ◽

Salvage Therapy ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

High Success Rate ◽

Bleeding Site ◽

Endoscopic Procedures ◽

Upper Gastrointestinal

Abstract Background A new hemostatic adhesive powder (UI-EWD) has been developed to reduce the high re-bleeding rates associated with the currently available hemostatic powders. The current study aimed to assess the efficacy of UI-EWD as a salvage therapy for the treatment of refractory upper gastrointestinal bleeding (UGIB). Methods A total of 17 consecutive patients who had failed to achieve hemostasis with conventional endoscopic procedures and had undergone treatment with UI-EWD for endoscopic hemostasis in refractory UGIB were prospectively enrolled in the study. We evaluated the success rate of initial hemostasis and rate of re-bleeding within 30 days. Results All patients underwent successful UI-EWD application at the bleeding site. Initial hemostasis occurred in 16/17 patients (94 %). Re-bleeding within 30 days occurred in 3/16 patients (19 %) who had achieved initial hemostasis. In the second-look endoscopy after 24 hours, hydrogel from UI-EWD was found attached at the bleeding site in 11/16 patients (69 %). Conclusion UI-EWD has a high success rate for initial hemostasis in refractory UGIB and shows promising results in the prevention of re-bleeding.

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Vascular Parenchymal Sources of Upper Gastrointestinal Bleeding

Acta Radiologica ◽

10.1177/028418518903000109 ◽

1989 ◽

Vol 30 (1) ◽

pp. 39-43 ◽

Cited By ~ 8

Author(s):

S. Savastano ◽

G. P. Feltrin ◽

D. Miotto ◽

M. Chiesura-Corona ◽

L. Rubaltelli ◽

...

Keyword(s):

Computed Tomography ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Emergency Endoscopy ◽

Severe Hemorrhage ◽

Group A ◽

Group B ◽

Upper Gastrointestinal ◽

Selection Of Patients ◽

Selection Of

Fourteen cases of upper gastrointestinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment.

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