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Risk of Bleeding with Endoscopic Ultrasound-Guided Tissue Acquisition in Patients on Antithrombotic Therapy: A Systematic Review and Meta-Analysis

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Abstract

Background

The present guidelines stratify endoscopic ultrasound-guided tissue acquisition (EUS-TA) as a high-bleeding risk procedure in patients on antithrombotics. However, the data regarding the same are conflicting. Therefore, this meta-analysis aimed to analyze the bleeding event rates associated with EUS-TA in patients receiving antithrombotic therapy.

Methods

A literature search from January 2000 to August 2022 was done for studies on EUS-guided TA in patients receiving antithrombotics. The primary outcome was incidence of overall and major bleeding. Pooled event rates across studies were expressed with summative statistics.

Results

A total of 12 studies were included in the meta-analysis. The pooled risk of overall bleeding and major bleeding in patients on antithrombotics was 2.0% (0.6–3.4) and 0.8% (0.0–1.6), respectively. In patients taking thienopyridine or anticoagulants, the pooled risk of overall bleeding and major bleeding was 2.4% (0.9–3.9) and 1.7% (0.4–3.1), respectively. Patients on antithrombotics had a higher odd of overall bleeding (OR 2.12, 1.20–3.83) and major bleeding (OR 3.58, 1.11–11.52) compared to controls. The odds of overall bleeding (OR 0.95, 95%CI 0.38–2.42) and major bleeding (OR 1.57, 95%CI 0.45–5.54) were comparable between patients on antithrombotics who continued and those who discontinued it preprocedural.

Conclusion

Despite an increase risk of bleeding with EUS-TA in patients on antithrombotics, the pooled incidence remains low. Compared to the previous guidelines stating thienopyridine use as high risk for bleeding, the present analysis showed a bleeding rate of less than 1%. Discontinuing antithrombotics prior to EUS-TA does not reduce the bleeding risk significantly, requiring strict monitoring.

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Authors and Affiliations

  1. Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad, India

    Suprabhat Giri & Sumaswi Angadi

  2. Institute of Gastrosciences and Liver, Apollo Multispecialty Hospital, Kolkata, India

    Shivaraj Afzalpurkar

  3. Department of Gastroenterology, SCB Medical College & Hospital, Cuttack, India

    Prajna Anirvan

  4. Department of Gastroenterology, Fortis Hospital, Bengaluru, India

    Sunil Kasturi

  5. Department of Gastroenterology, KM Cherian Institute of Medical Sciences, Kallissery, India

    Jijo Varghese

  6. Department of Digestive Disease and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, 400012, India

    Sridhar Sundaram

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Contributions

SG, SAf, PA, SAn, SK, JV, and SS contributed to conception of the work, the acquisition, analysis, or interpretation of data for the work, drafting the work, critical revision, and final approval of the version. SG, SAf, PA, SAn, SK, JV, and SS agree to be accountable for all aspects of the work.

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Correspondence to Sridhar Sundaram.

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Giri, S., Afzalpurkar, S., Anirvan, P. et al. Risk of Bleeding with Endoscopic Ultrasound-Guided Tissue Acquisition in Patients on Antithrombotic Therapy: A Systematic Review and Meta-Analysis. Dig Dis Sci 68, 1950–1958 (2023). https://doi.org/10.1007/s10620-022-07808-x

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  • DOI: https://doi.org/10.1007/s10620-022-07808-x

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