Do aspirin and non-steroidal anti-inflammatory drugs increase the risk of post-sphincterotomy hemorrhage – A case-control study

• Published in: Clinics and research in hepatology and gastroenterology 2013-04, Vol.37 (2), p.171-176
• Main Authors: Onal, Ibrahim Koral, Parlak, Erkan, Akdogan, Meral, Yesil, Yusuf, Kuran, Sedef Ozdal, Kurt, Mevlut, Disibeyaz, Selcuk, Ozturk, Eda, Odemis, Bulent
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Aspirin - administration & dosage; Aspirin - adverse effects; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Case-Control Studies; Comorbidity; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Internal Medicine; Male; Medical sciences; Middle Aged; Partial Thromboplastin Time; Pharmacology. Drug treatments; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Postoperative Hemorrhage - etiology; Prospective Studies; Prothrombin Time; Renal Dialysis - adverse effects; Risk Factors; Sphincterotomy, Endoscopic; Thrombocytopenia - complications; Young Adult
• ISSN: 2210-7401; 2210-741X
• DOI: 10.1016/j.clinre.2012.04.010

Summary Background and objective Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin have antiaggregant properties and patients with pancreaticobiliary disease commonly use these drugs. We prospectively investigated whether aspirin and NSAIDs are associated with endoscopic sphincterotomy related hemorrhage. Methods Three hundred and eight patients who underwent sphincterotomy were sequentially recruited into this prospective case-control study. Pre-endoscopic assessment included a complete blood count, coagulation studies and a detailed drug history after sphincterotomy patients were followed up for bleeding. Cases and controls were compared for patient and procedure-related risk factors of post-endoscopic sphincterotomy bleeding. Results Hemorrhage occured in 74 (24%) patients. Eight (2.6%) were clinically significant and five (1.6%) were severe. Amongst cases with hemorrhage, 17.6% were on NSAIDs and 14.9% on aspirin; 27.4% of controls took NSAIDs, and 9.8% aspirin ( P > 0.05). Aspirin use in patients with significant (12.5%) or severe hemorrhage (20%) was not different from the controls ( P > 0.05) and none of them had NSAIDs prior to sphincterotomy. Based on univariate analysis, coagulopathy and comorbidity were risk factors for significant post-sphincterotomy hemorrhage and coagulopathy was the only independent parameter (odds ratio = 22.72, 95% CI [4.25; 125]). Conclusion Aspirin and NSAIDs do not increase the risk of post-sphincterotomy hemorrhage and they can be safely used before the procedure.