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A prospective, multicenter survey on the validity of shorter periendoscopic cessation of antithrombotic agents in Japan

  • Original Article—Alimentary Tract
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Abstract

Background

The management of antithrombotic agents for endoscopic procedures has recently focused on preventing periprocedural thrombosis in Western countries. However, this focus on shorter cessation of antithrombotic agents needs to be examined for its implications for post-procedural bleeding, with potential risk factors for such bleeding clarified in real-world clinical settings in Japan.

Methods

A Sapporo consensus group convened and developed a consensus document on the criteria for cessation of antithrombotic agents. In the multicenter, prospective, observational study that followed to validate the criteria in a real-world clinical setting, of all patients ≥20 years of age receiving antithrombotic agents and undergoing endoscopic procedures, all consenting patients were enrolled. All participating facilities were followed up on their adherence to the criteria and clinical outcomes, such as the occurrence of post-procedural bleeding and thrombosis.

Results

A total of 5250 patients, who accounted for 6944 endoscopic procedures, were enrolled from 19 study sites. The consensus criteria, which proved to be nearly consistent with the JSGE criteria revised in 2012, had been adhered to in a total of 6531 procedures performed in 4921 patients. Bleeding and thrombosis were reported in 53 (0.76 %) and two (0.03 %) patients, respectively, among those receiving antithrombotic agents. Post-procedural bleeding was significantly associated with high-bleeding-risk procedures, a high thromboembolic risk with heparin bridging, and the presence of renal failure/dialysis.

Conclusions

With the new criteria in place for cessation of antithrombotic agents focused on prevention of periprocedural thrombosis, endoscopic procedures may be safely performed without substantially increasing bleeding in clinical practice in Japan.

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Acknowledgments

Sapporo Consensus Group The Sapporo Consensus Group comprised the following hospitals (participants): Hokkaido University Hospital (K. Mabe, M. Kato); Sapporo Medical University School of Medicine (K. Yamashita); KKR Sapporo Medical Center (H. Seki, Y. Ishibashi); Otaru Ekisaikai Hospital (S. Katsuki, K. Takanashi); Nakagawa Ichoka Clinic (S. Nakagawa); Kushiro Rosai Hospital (K. Takahashi); Sapporo Higashi Tokushukai Hospital (K. Kimura); Hakodate Municipal Hospital (K. Yamamoto); Keiwakai Ebetsu Hospital (K. Shinada); Keiyukai Sapporo Hospital (J. Kodaira); Japanese Red Cross Kitami Hospital (M. Uebayashi); Kinikyo Sapporo-Nishiku Hospital (S. Imazu); Sapporo Hokuyu Hospital (M. Kudo); Otaru Kyokai Hospital (M. Hirayama); Abashiri Kosei General Hospital (M. Onodera); IMS Sapporo Hospital (Y. Konno); Shibetsu City Hospital (T. Sato); Hakodate Chuo Hospital (J. Konno); and Teine-Keijinkai Hospital (T. Tanuma).

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Authors and Affiliations

  1. Department of Gastroenterology, National Hospital Organization Hakodate Hospital, 18-16, Kawahara-cho, Hakodate City, Hokkaido, 041-8512, Japan

    Katsuhiro Mabe

  2. Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan

    Mototsugu Kato & Shoko Ono

  3. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Koji Oba

  4. Nakagawa Ichoka-Clinic, Sapporo, Japan

    Soichi Nakagawa

  5. Center of Gastroenterology, KKR Sapporo Medical Center, Sapporo, Japan

    Hideyuki Seki

  6. Center of Gastroenterology, Otaru Ekisaikai Hospital, Otaru, Japan

    Shinichi Katsuki

  7. Department of Gastroenterology, Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, Sapporo, Japan

    Kentaro Yamashita

  8. Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Yuichi Shimizu & Naoya Sakamoto

Authors
  1. Katsuhiro Mabe
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  2. Mototsugu Kato
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  3. Koji Oba
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  4. Soichi Nakagawa
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  6. Shinichi Katsuki
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  8. Shoko Ono
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  9. Yuichi Shimizu
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  10. Naoya Sakamoto
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The Sapporo Consensus Study Group

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Correspondence to Katsuhiro Mabe.

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Additional information

The members of the Sapporo Consensus Study Group are listed in the Acknowledgments.

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Mabe, K., Kato, M., Oba, K. et al. A prospective, multicenter survey on the validity of shorter periendoscopic cessation of antithrombotic agents in Japan. J Gastroenterol 52, 50–60 (2017). https://doi.org/10.1007/s00535-016-1203-3

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  • DOI: https://doi.org/10.1007/s00535-016-1203-3

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