38 (S0593). - Outcomes of Perioperative Management in Patients on Direct-Oral Anticoagulant or Anti-Platelet Therapy in the Setting of Urgent Gastrointestinal Endoscopic Procedures

David J. Leung, MD, MS¹, Alexander Prevallet, DO¹, Rohit Khanna, DO¹, Behnam Moein Jahromi, MD², Samantha Spierling Bagsic, PhD³, Jill A. Lane, MD⁴, Gauree G. Konijeti, MD, MPH⁴; ¹Scripps Mercy Hospital, San Diego, CA; ²Scripps Clinic / Scripps Green Hospital, San Diego, CA; ³Scripps Whittier Diabetes Institute, San Diego, CA; ⁴Scripps Clinic, La Jolla, CA

Introduction: Antithrombotic therapy (ATT), including aspirin (ASA), anticoagulant (AC) and antiplatelet (AP) agents reduce risk of thromboembolic events but can increase risk of gastrointestinal bleeding (GIB), including after GI endoscopy (GIE). Guidelines for perioperative management of GIE aim to reduce patient and procedural risk. We examined whether use of ATT other than ASA alone affects risk of adverse GI or cardiovascular (CV) outcomes following urgent GIE for GIB.

Methods: We performed a retrospective cohort study of patients on ATT hospitalized 1/2017-1/2019 who underwent urgent GIE for overt or occult GIB during the same admission. Cases were defined as patients on AC or AP agents, with or without ASA, whereas controls were on ASA alone or no ATT. Timing of ATT discontinuation before and resumption after GIE was examined. The primary outcome was adverse events (AEs) within 30 days following GIE, including major GIB, clinically relevant non-major GIB (CRNMB), CV events, 30-day rehospitalization and death. Multivariate logistic regression model including age, gender, and significant predictors on univariate analyses was analyzed to identify significant predictors of outcomes.

Results: Among 564 cases and 363 controls, median age was 76 (SD±12) and majority male (59.3%). Use of ASA in controls was 44.4% (161/363). Among cases, use of ASA was 48.6%, AP 42.4%, AC 50.4%, and 50.7% were on 2 or more ATTs. Incidence of CRNMB was higher in cases than controls (35.1% vs 25.3%, p< 0.002). There was no significant difference between the 2 groups in risk of major GIB, CV events, 30-day rehospitalization or death (Table 1). Major GIB risk decreased with low-risk GIE (cases, OR 0.33, 95% CI 0.19-0.59; controls, OR 0.27, CI 0.13-0.58), but increased in cases on low-molecular weight heparin (OR 2.69, CI 1.29-5.32). Among controls, risk of CV was increased with history of coronary artery disease (OR 3.02, CI 1.17-7.80), venous thromboembolism (OR 5.82, CI 2.13-15.79), and discontinuation of ASA >48 hours prior to GIE (OR 3.49, CI 1.05-10.07). Timing of resumption ATT after GIE did not affect 30-day outcomes in either group.

Discussion: Among hospitalized patients undergoing urgent GIE for GIB, we observed no increased risk of major GIB, CV events or death if they were on ATT versus no ATT or ASA alone. However, ATT other than ASA alone may increase risk of CRNMB in this setting.


Table 1: Comparison of outcomes between patients who were on ATT and patients who were either on no ATT or ASA alone

Disclosures:
David Leung indicated no relevant financial relationships.
Alexander Prevallet indicated no relevant financial relationships.
Rohit Khanna indicated no relevant financial relationships.
Behnam Moein Jahromi indicated no relevant financial relationships.
Samantha Spierling Bagsic indicated no relevant financial relationships.
Jill Lane indicated no relevant financial relationships.
Gauree Konijeti indicated no relevant financial relationships.