P2774 - Outcomes of ERCP With Sphincterotomy in Patients on Antiplatelet and Anticoagulation Therapy: A Propensity-Matched Cohort Analysis

Saqr Alsakarneh, MD¹, Fouad Jaber, MD¹, Yazan Abboud, MD², Khaled Alsabbagh Alchirazi, MD³, Mohammad Bilal, MD⁴, Shifa Umar, MD^5
1University of Missouri - Kansas City School of Medicine, Kansas City, MO; ²Rutgers New Jersey Medical School, Newark, NJ; ³Aurora Healthcare, Brookfield, WI; ⁴University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN; ⁵Baylor College of Medicine / Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX

Introduction: The safety of endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy in patients on antiplatelet (APT) or anticoagulation (AC) therapy remains unclear. We aimed to investigate the safety of ERCP with sphincterotomy in patients on AC or APT therapy using a national database.

Methods: We conducted a retrospective cohort study using the TriNetX database to identify patients ≥18 years undergoing ERCP with sphincterotomy. Patients were divided into two cohorts: (1) receiving APT (clopidogrel, ticagrelor, prasugrel, aspirin) or (2) AC therapy within 5 days of ERCP. Using 1:1 propensity score matching, patients in the APT or AC cohort were matched with patients without a history of AC or APT use who underwent ERCP with sphincterotomy. The primary outcome was the incidence of gastrointestinal bleeding (GIB) within 28 days of ERCP. Secondary outcomes included the need for repeat ERCP or EGD, blood transfusion, intensive care unit (ICU) care, and all-cause mortality within 28 days of ERCP.

Results: 24,080 patients (APT: 19505; AC: 4575) were included in this study. Patients on APT or AC therapy had a higher risk of GIB within 28 days of ERCP (aOR: 1.51 [95% CI: 1.34 - 1.67] and aOR: 1.54 [95% CI: 1.27 - 1.85], respectively) compared to patients not on APT or AC therapy (Table 1). On subgroup analysis, the risk of GIB was increased in patients taking P2Y12 receptor inhibitors (aOR: 1.65 [95% CI 1.28 - 2.13]), warfarin (aOR: 1.8 [95% CI 1.29 - 2.9]), and direct anticoagulation therapy (DOAC) (aOR: 1.48 [95% CI 1.18 - 1.87]), but there was no increased risk of GIB with Aspirin alone (aOR: 1.13; 95% CI: 0.97 – 1.33). Patients on AC or APT had a higher risk of requiring blood transfusion (ACT: aOR: 1.27 [95% CI 1.01 - 1.59]; APT: (aOR: 1.42 [95% CI 1.25 - 1.62]), but there was no difference in the incidence of needing repeat EGD or ERCP (APT: aOR: 0.98 [95% CI 0.84 – 1.16]; AC: aOR: 1.31 [95% CI 0.99 - 1.78]). Most patients (61.5% AC, 61.9% APT) resumed their medications within 2 days of sphincterotomy.

Discussion: Patients on APT or AC therapy have a higher risk of GIB post-ERCP with sphincterotomy compared to propensity-matched controls, while the risk of bleeding is not increased on Aspirin. The increased risk is particularly notable in patients taking P2Y12 receptor inhibitors or warfarin. Therefore, an appropriate drug cessation period should be considered in patients on APT or AC therapy undergoing ERCP with sphincterotomy.


Disclosures:


Saqr Alsakarneh, MD¹, Fouad Jaber, MD¹, Yazan Abboud, MD², Khaled Alsabbagh Alchirazi, MD³, Mohammad Bilal, MD⁴, Shifa Umar, MD⁵. P2774 - Outcomes of ERCP With Sphincterotomy in Patients on Antiplatelet and Anticoagulation Therapy: A Propensity-Matched Cohort Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.