title: A prospective, multicenter survey on the validity of shorter periendoscopic cessation of antithrombotic agents in Japan.
abstract: BACKGROUND
  The management of antithrombotic agents for endoscopic procedures has recently focused on preventing periprocedural thrombosis in Western countries. However, this focus on shorter cessation of antithrombotic agents needs to be examined for its implications for post-procedural bleeding, with potential risk factors for such bleeding clarified in real-world clinical settings in Japan.
  
  
  METHODS
  A Sapporo consensus group convened and developed a consensus document on the criteria for cessation of antithrombotic agents. In the multicenter, prospective, observational study that followed to validate the criteria in a real-world clinical setting, of all patients ≥20 years of age receiving antithrombotic agents and undergoing endoscopic procedures, all consenting patients were enrolled. All participating facilities were followed up on their adherence to the criteria and clinical outcomes, such as the occurrence of post-procedural bleeding and thrombosis.
  
  
  RESULTS
  A total of 5250 patients, who accounted for 6944 endoscopic procedures, were enrolled from 19 study sites. The consensus criteria, which proved to be nearly consistent with the JSGE criteria revised in 2012, had been adhered to in a total of 6531 procedures performed in 4921 patients. Bleeding and thrombosis were reported in 53 (0.76 %) and two (0.03 %) patients, respectively, among those receiving antithrombotic agents. Post-procedural bleeding was significantly associated with high-bleeding-risk procedures, a high thromboembolic risk with heparin bridging, and the presence of renal failure/dialysis.
  
  
  CONCLUSIONS
  With the new criteria in place for cessation of antithrombotic agents focused on prevention of periprocedural thrombosis, endoscopic procedures may be safely performed without substantially increasing bleeding in clinical practice in Japan.
authors.affiliation: Department of Gastroenterology, National Hospital Organization Hakodate Hospital, 18-16, Kawahara-cho, Hakodate City, Hokkaido, 041-8512, Japan. kmabe@hnh.hosp.go.jp.
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Mabe
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Oba
authors.affiliation: Nakagawa Ichoka-Clinic, Sapporo, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Center of Gastroenterology, KKR Sapporo Medical Center, Sapporo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Seki
authors.affiliation: Center of Gastroenterology, Otaru Ekisaikai Hospital, Otaru, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Katsuki
authors.affiliation: Department of Gastroenterology, Rheumatology and Clinical Immunology, Sapporo Medical University School of Medicine, Sapporo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Ono
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: Bleeding; Criteria for antithrombotic drug cessation; Endoscopic procedures; Management of antithrombotic agents