What is the clinical evidence from this study?

Study design: Cohort. Population: High-risk endoscopic procedures (n=36201). Intervention: Peri-procedural antithrombotic drug management (continuation, discontinuation, or replacement) vs. Nonusers of antithrombotic drugs. Primary outcome: 30-day bleeding requiring endoscopic hemostasis.

What does this research mean for the field?

Peri-procedural antithrombotic drug management during high-risk endoscopic procedures results in absolute bleeding risk differences of less than 10% for upper-GI and less than 5% for lower-GI procedures compared to nonusers. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to investigate how different management strategies for antithrombotic drugs affect bleeding risk during high-risk endoscopic procedures.

May 21, 2026

Association between antithrombotic drug management and bleeding during high-risk endoscopic procedures: A multi-center retrospective observational study

Key Result

Peri-procedural antithrombotic drug management during high-risk endoscopic procedures resulted in absolute bleeding risk differences of <10% for upper-GI and <5% for lower-GI compared to nonusers.

Key Points

This study aims to investigate how different management strategies for antithrombotic drugs affect bleeding risk during high-risk endoscopic procedures.
Conducted a multicenter, retrospective cohort study on high-risk endoscopic procedures.
Categorized antithrombotic drug management into continuation, discontinuation, and replacement.
Evaluated the bleeding risk differences among antithrombotic drug management groups compared to nonusers.
30-day bleeding occurred in 5.89% of upper-GI and 1.22% of lower-GI procedures.
Aspirin continuation and thienopyridine discontinuation were associated with higher bleeding rates during gastric ESD compared to nonusers.
Overall, bleeding risk differences were observed, particularly in upper-GI procedures, but remained within 10%.

Study Design

Type

Cohort (n=36,201)

Multicenter

Yes

Structured PICO

Does peri-procedural antithrombotic drug management affect the risk of 30-day bleeding requiring endoscopic hemostasis in patients undergoing high-risk endoscopic procedures?

Population

Patients undergoing high-risk endoscopic procedures, including upper-GI (esophageal ESD, elective EVL, gastric ESD, PEG) and lower-GI (colonic polypectomy/EMR, colonic ESD) procedures.

Intervention

Peri-procedural management of antithrombotic drugs (continuation, discontinuation, or replacement of aspirin, thienopyridine, warfarin, or DOACs).

Comparator

Patients who did not take antithrombotic drugs (nonusers).

Outcome

30-day bleeding requiring endoscopic hemostasis.safety

Peri-procedural antithrombotic drug management during high-risk endoscopic procedures is associated with small absolute increases in 30-day bleeding risk (<10% for upper-GI, <5% for lower-GI) compared to nonusers.

Abstract

ABSTRACT Background lower-GI procedures included 23326 colonic polypectomy/EMRs and 2769 colonic ESDs. ATDs management included aspirin continuation (n=818) and discontinuation (n=62); thienopyridine discontinuation (n=188) and replacement (n=97); warfarin continuation (n=97) and discontinuation (n=20); DOAC discontinuation (n=487). Thirty-day bleeding occurred in 5.89% of upper-GI and 1.22% of lower-GI procedures. Bleeding risk differed according to antithrombotic drug management. In upper-GI procedures, numerically higher bleeding rates were observed in some antithrombotic management groups, particularly aspirin continuation and thienopyridine discontinuation during gastric ESD, compared with nonusers; however, the absolute risk differences were within 10%. In contrast, bleeding risk differences in lower-GI procedures were smaller overall and within 5%. Conclusions: This multicenter study describes differential bleeding risk patterns across high-risk endoscopic procedures among patients receiving antithrombotic therapy.

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