Risk of thromboembolic events in relation to the management of anticoagulant and antiagregant therapy in patients subjected to endoscopic retrograde cholangiopancreatography

Background and objectives: The main clinical practice guidelines recommend adequate peri-procedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anti-coagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. Patients and methods: A prospective observational study was carried out, which included 644 ERCP performed with therapeutic intention during 2019 at the Reina Sofia University Hos-pital with follow-up during the 30 days after the endoscopic intervention. Results: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P > .05). The incidence of throm-botic events was significantly higher in patients treated with heparin or apixaban (P = .001), as well as with a history of atrial fibrillation (P = .05), rheumatic valve disease (P = .037) and recurrent pulmonary embolism (P = .035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30 days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P = .04). Conclusions: Inadequate periprocedural management of antithrombotic therapy is not associa-ted with a significant increase in the incidence of thromboembolic events in the 30 days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis. (c) 2022 Elsevier Espana, S.L.U. All rights reserved.