Anticoagulants up risk of bleeding after esophageal dilation procedure

Patients taking anticoagulant medications at the time of esophageal dilation are at increased risk of experiencing gastrointestinal bleeding after the procedure, suggests a study.

The use of dual-antiplatelet therapies (DAPT) is associated with a higher risk of bleeding, albeit statistically nonsignificant.

Researchers conducted a retrospective propensity-matched cohort study to evaluate patients in the TriNetX US Collaborative Network database who underwent esophageal dilation procedures. The effect of anticoagulants and DAPTs on the rate of postprocedural gastrointestinal bleeding within 30 days was the primary outcome.

Patients on anticoagulants were more likely to develop postprocedural bleeding than those not on anticoagulants (relative risk [RR], 1.43, 95 percent confidence interval [CI], 1.06‒1.92; p=0.017). The anticoagulant group had higher rates of blood transfusion and intensive care unit (ICU) admission.

Furthermore, the DAPT group showed a higher rate of gastrointestinal bleeding than the no antiplatelet therapy group, but this did not reach statistical significance (RR, 1.64, 95 percent CI, 0.97‒2.75; p=0.06). Likewise, the difference in bleeding rates did not reach significance when comparison was made with aspirin monotherapy (RR, 1.36, 95 percent CI, 0.84‒2.19; p=0.2).

The DAPT group also showed no significant differences with the aspirin and no antiplatelet groups in the rates of blood transfusion or ICU admission.

Notably, early resumption of anticoagulation or antiplatelet therapy did not increase the risk of postprocedural bleeding.

“These findings aim to inform the clinical decision making in preprocedure and postprocedure management of esophageal dilation procedures,” the researchers said.