Endoscopy 2019; 51(04): S29-S30
DOI: 10.1055/s-0039-1681256
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: Capsule – enteroscopy Club B
Georg Thieme Verlag KG Stuttgart · New York

RISK OF SMALL BOWEL BLEEDING ASSOCIATED WITH USE OF ORAL ANTICOAGULANTS OR ANTIPLATELET AGENTS: A RETROSPECTIVE COHORT STUDY

A Mussetto
1   Santa Maria delle Croci Hospital, Gastroenterology, Ravenna, Italy
,
AT Garribba
1   Santa Maria delle Croci Hospital, Gastroenterology, Ravenna, Italy
,
S Gasperoni
1   Santa Maria delle Croci Hospital, Gastroenterology, Ravenna, Italy
,
O Triossi
1   Santa Maria delle Croci Hospital, Gastroenterology, Ravenna, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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    Aims:

    Antiplatelet and anticoagulant therapy is increasingly being used for cardiovascular prevention. Novel direct-acting oral anticoagulants (NOAC) represent a recent, alternative, family of drugs. Rate of bleeding complications by NOAC seems to be comparable to those of warfarin but a previously assumed increase in gastrointestinal bleeding complications was meanwhile confirmed. The risk of bleeding in the setting of suspected small bowel bleeding (SSBB) in patients taking antiplatelets or anticoagulants has been poorly investigated.

    Aim of this study was to evaluate diagnostic yield using video capsule endoscopy in SSBB patients taking antiplatelets or anticoagulants.

    Methods:

    This is a retrospective review of chronic users of anticoagulants or antiplatelet agents who underwent VCE for SSBB. Small bowel findings were evaluated using Mirocam VCE (Intromedic, Korea).

    Results:

    264 patients (134 women, mean age 72.3 years, 55% occult SSBB) underwent VCE from January 2014 to March 2018 for SSBB. 162 out of 264 patients were taking antiplatelets or anticoagulants agents. 44 patients were taking 100 mg of enteric-coated aspirin, 24 taking thienopyridine (ticlopidine or clopidogrel), 39 taking aspirin combined with thienopyridine (combined group), 27 taking warfarin and 28 patients taking NOAC (20% dabigatran, 32% apixaban, 48% rivaroxaban). Diagnostic yield in this specific cohort was 54.9%. Relevant lesions were most frequently detected in the “combined” group (74.3%) among the five groups (aspirin group 52.2%, NOAC group 50%, warfarin group 48.1%, thienopyridine group 41.6%) (p < 0.05).

    Conclusions:

    The risk of small bowel bleeding related to antiplatelet/anticoagulant therapy seems to be increased in patients taking the combination of aspirin and thienopyridine and preventive strategies in this group should be established. The risk related to novel oral anticoagulants seems to be similar to that for warfarin and aspirin alone.


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