title: Prospective analysis of risk for bleeding after endoscopic biopsy without cessation of antithrombotics in Japan.
abstract: OBJECTIVE
  In Japan, after the revision of the gastrointestinal endoscopic guidelines for patients taking antithrombotics, endoscopic biopsies were permitted while continuing antithrombotic treatment. However, the risk of bleeding after the biopsy with or without cessation of antithrombotics has not been fully evaluated because bleeding events are very rare. The aim of this prospective study was to evaluate the risk for bleeding after upper gastrointestinal biopsy without cessation of antithrombotics.
  
  
  METHODS
  Consecutive patients who underwent upper gastrointestinal endoscopic biopsy from December 2011 to March 2014 were enrolled in this study. Antithrombotic medication and its cessation status was checked at enrollment. To confirm bleeding events associated with biopsy, medical examination at the hospital or direct confirmation by telephone was done within 1 month after the biopsy.
  
  
  RESULTS
  Among the 3758 patients who underwent endoscopic biopsies, 394 patients (10.5%) were medicated with antithrombotics, and 286 of them (72.6% of the total antithrombotics users) did not undergo cessation. Bleeding after the biopsy occurred in six cases (0.15%, 95% CI; 0.09%∼0.22%), but there was only one case that had continued taking antithrombotics. The incidence of bleeding after biopsy was not significantly higher in the patients who had continued taking antithrombotics compared with the others (0.35% vs 0.14%, P = 0.38).
  
  
  CONCLUSIONS
  This prospective study showed that continuation of antithrombotics did not increase the bleeding risk after upper gastrointestinal endoscopic biopsy.
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ara
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Iijima
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Ryuhei
authors.initials: R
authors.lastname: Maejima
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kondo
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Kusaka
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Waku
authors.initials: W
authors.lastname: Hatta
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Kaname
authors.initials: K
authors.lastname: Uno
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Asano
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Koike
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Imatani
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D005343:Fibrinolytic Agents
keywords: antithrombotic; biopsy; bleeding; complication; endoscopy