Safety and effectiveness of peroral endoscopic myotomy in patients on antiplatelet or anticoagulant therapy: an international multicenter case-control study
Publication in refereed journal


摘要Background and Aims: The risk of bleeding and thromboembolic events in patients undergoing peroral endoscopic myotomy (POEM) who are receiving antithrombotic therapy is unknown. Our primary aim was to assess the safety of POEMin this patient subset. Secondary outcomeswere rates of clinical success, GERD, and procedure-related outcomes.Methods: This was an international, 1:1, case-control study performed at 10 centers using prospectively maintained databases. All consecutive patients who underwent POEM before November 2019 were considered for inclusion. Cases were patients on antiplatelet and/or anticoagulant therapy. Controls not receiving antithrombotics were matched for age and esophageal motility disorder. Primary outcomes were major bleeding and thromboembolic events on postprocedural day 30.Results: Of 2895 patients who underwent POEM, 126 cases (103 on antiplatelets, 35 anticoagulants, 12 both) and 126 controls were enrolled. The rate of major bleeding was higher for the antithrombotics users (5.6% vs 0.8%, PZ.03). Anticoagulants and clopidogrel were temporarily interrupted in all cases. Aspirin was continued in 40.5% of users without increasing the bleeding risk. One thromboembolic event occurred in each group (0.79%; P Z 1.00). No POEM-related deaths were noted. Rates of clinical success (91.7% vs 96% in controls, P Z.20), postprocedural GERD, and technical-related outcomes were similar in both groups. Antithrombotic management was heterogeneous, and guidelines were not adhered to in 23.8% of cases.Conclusions: POEM is safe and effective in patients receiving antithrombotic therapy although it is associated with a greater risk of major bleeding.
著者de Santiago ER, Shimamura Y, Pioche M, Eleftheriadis N, Albeniz E, Bechara R, Chiu PWY, Guarner-Argente C, de Tejada AH, Uchima H, Fujiyoshi Y, Ponchon T, Gonzalez-Gete G, Hew S, Murzi-Pulgar M, Matallana V, Parejo-Carbonell S, Estremera-Arevalo F, Moll F, Onimaru M, Inoue H
期刊名稱Gastrointestinal Endoscopy
頁次839 - 849
Web of Science 學科類別Gastroenterology & Hepatology;Gastroenterology & Hepatology

上次更新時間 2021-16-06 於 00:11