Bleeding risk of endoscopic ultrasound‐guided fine‐needle aspiration in patients undergoing antithrombotic therapy

• Published in: Digestive endoscopy 2017-01, Vol.29 (1), p.91-96
• Main Authors: Inoue, Tadahisa, Okumura, Fumihiro, Sano, Hitoshi, Kobayashi, Yuji, Ishii, Norimitsu, Suzuki, Yuta, Fukusada, Shigeki, Kachi, Kenta, Ozeki, Takanori, Anbe, Kaiki, Iwasaki, Hiroyasu, Mizushima, Takashi, Ito, Kiyoaki, Yoneda, Masashi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anticoagulant agents; antiplatelet agents; antithrombotic agents; bleeding; Blood Loss, Surgical - statistics & numerical data; Digestive System Diseases - diagnosis; Digestive System Diseases - surgery; Endoscopic Ultrasound-Guided Fine Needle Aspiration - adverse effects; endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA); Endoscopy, Gastrointestinal - adverse effects; Female; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Humans; Incidence; Japan - epidemiology; Male; Middle Aged; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - etiology; Retrospective Studies; Risk Assessment; Risk Factors; Survival Rate - trends; Thromboembolism - prevention & control; Ultrasonography, Doppler; Young Adult
• ISSN: 0915-5635; 1443-1661
• DOI: 10.1111/den.12687

Objectives Bleeding events related to endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) are rare. However, for patients treated with antithrombotic agents, the bleeding risk of EUS‐FNA is uncertain. Hence, the aim of this study was to assess the bleeding event rate associated with EUS‐FNA in patients receiving antithrombotic treatment. Methods A retrospective study was conducted in 742 consecutive patients who underwent EUS‐FNA for solid lesions between 2008 and 2015. We compared the bleeding event rates among patients who were not administered antithrombotic agents, those whose agent use was discontinued, those who continued treatment with aspirin or cilostazol, and those who were administered heparin as a replacement. Results There were 131 patients (17.7 %) treated with antithrombotic agents. Seven experienced bleeding events, and the overall bleeding event rate was 0.9 % (7/742). All bleeding events were intraoperative; there were no postoperative bleeding episodes. Subgroup analysis by antithrombotic agent revealed bleeding event rates of 1.0 % (6/611), 0 % (0/62), 1.6 % (1/61), and 0 % (0/8) for the non‐administration, discontinuation of agents, continuation of aspirin or cilostazol, and heparin replacement groups, respectively. Only one severe bleeding event necessitated hemostatic treatment (1/742; 0.1 %); this occurred in a patient in the non‐administration group, and there were no severe bleeding events in patients receiving antithrombotic treatment. Conclusions The present study found a low incidence of EUS‐FNA‐related bleeding in patients receiving antithrombotic treatment. The bleeding event rate was low even in patients who underwent EUS‐FNA while continuing aspirin or cilostazol.