title: Multicenter study on hemorrhagic risk of heparin bridging therapy for periendoscopic thromboprophylaxis.
abstract: BACKGROUND
  For endoscopic interventions, heparin bridging therapy is recommended in patients who are at high risk from interruption of antithrombotic therapy. Although heparin bridging has been reported to be effective in preventing thrombosis, several reports have raised concerns about increased risk of bleeding. The aim of this study was to clarify complications of hepari bridging therapy in therapeutic endoscopy.
  
  
  METHODS
  A nationwide multicenter survey using questionnaire was performed about patients undergoing therapeutic endoscopy with heparin bridging. Patients who underwent therapeutic endoscopy without heparin bridging therapy were considered as controls. Compliance scores of heparin bridging therapy guideline were employed, and association was analyzed between the score and occurrence of post-procedural bleeding.
  
  
  RESULTS
  The incidence of post-procedural bleeding was significantly higher (13.5%, 33/245) in the heparin group compared with the control group (2.7%, 299/11102)(p < 0.001). Thrombosis occurred in 1 patient each in the two groups. In the heparin group, post-procedural bleeding was more likely to be delayed bleeding. Dose adjustment of heparin was a significant factor contributing to bleeding. The compliance score of heparin bridging therapy guideline was significantly higher in those who suffered bleeding.
  
  
  CONCLUSIONS
  Heparin bridging therapy significantly increased the risk of post-procedural bleeding compared with the control. The bleeding risk was associated with greater adherence with guidelines for heparin bridging therapy.
authors.affiliation: Department of Gastroenterology, Sapporo Medical Center NTT EC, 〒060-0061 South 1 West 15, Chuo-ku, Sapporo, Hokkaido, Japan. miosakra@outlook.jp.
authors.forename: Mio
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, 〒060-0814 North 14, West 5, Kita-ku, Sapporo, Hokkaido, Japan. katsumabe@me.com.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Mabe
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, 〒060-0814 North 14, West 7, Kita-ku, Sapporo, Hokkaido, Japan. momoko0221tsuda@gmail.com.
authors.forename: Momoko
authors.initials: M
authors.lastname: Tsuda
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, 〒060-0814 North 14, West 7, Kita-ku, Sapporo, Hokkaido, Japan. cdf41180@par.odn.ne.jp.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Ono
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, 〒060-0814 North 14, West 7, Kita-ku, Sapporo, Hokkaido, Japan. m990053@live.jp.
authors.forename: Saori
authors.initials: S
authors.lastname: Omori
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, 〒060-0814 North 14, West 5, Kita-ku, Sapporo, Hokkaido, Japan. mskztakahashi@gmail.com.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, 〒060-0814 North 14, West 5, Kita-ku, Sapporo, Hokkaido, Japan. peugeot307ccs16@gmail.com.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, 〒060-0814 North 14, West 5, Kita-ku, Sapporo, Hokkaido, Japan. sho_sho_ono@yahoo.co.jp.
authors.forename: Shoko
authors.initials: S
authors.lastname: Ono
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, 〒060-0814 North 14, West 5, Kita-ku, Sapporo, Hokkaido, Japan. manabu-h@med.hokudai.ac.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, 〒060-0814 North 14, West 5, Kita-ku, Sapporo, Hokkaido, Japan. kenichi-nakagawa@hokkaido.med.or.jp.
authors.forename: Soichi
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, 〒060-0814 North 14, West 7, Kita-ku, Sapporo, Hokkaido, Japan. yshimizu@med.hokudai.ac.jp.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Department of Gastroenterology, Sapporo City General Hospital, 〒060-8604 North 11, West 13, Chuo-ku, Sapporo, Hokkaido, Japan. endoscopy@aol.jp.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, 〒060-0814 North 14, West 7, Kita-ku, Sapporo, Hokkaido, Japan. sakamoto@med.hokudai.ac.jp.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, 〒060-0814 North 14, West 5, Kita-ku, Sapporo, Hokkaido, Japan. m-kato@med.hokudai.ac.jp.
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Kato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D019983:Guideline Adherence; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000209:etiology*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin