Objective To compare the risks of postendoscopy outcomes associated with warfarin with direct oral anticoagulants (DOACs), taking into account heparin bridging and various types of endoscopic procedures. Design Using the Japanese Diagnosis Procedure Combination database, we identified 16 977 patients who underwent 13 types of high-risk endoscopic procedures and took preoperative warfarin or DOACs from 2014 to 2015. One-to-one propensity score matching was performed to compare postendoscopy GI bleeding and thromboembolism between the warfarin and DOAC groups. Results In the propensity score-matched analysis involving 5046 pairs, the warfarin group had a significantly higher proportion of GI bleeding than the DOAC group (12.0% vs 9.9%; p=0.002). No significant difference was observed in thromboembolism (5.4% vs 4.7%) or in-hospital mortality (5.4% vs 4.7%). The risks of GI bleeding and thromboembolism were greater in patients treated with warfarin plus heparin bridging or DOACs plus bridging than in patients treated with DOACs alone. Compared with percutaneous endoscopic gastrostomy, patients who underwent endoscopic submucosal dissection, endoscopic mucosal resection and haemostatic procedures including endoscopic variceal ligation or endoscopic injection sclerotherapy were at the highest risk of GI bleeding among the 13 types of endoscopic procedures, whereas those who underwent lower polypectomy endoscopic sphincterotomy or endoscopic ultrasound-guided fine needle aspiration were at moderate risk. Conclusion The risk of postendoscopy GI bleeding was higher in warfarin than DOAC users. Heparin bridging was associated with an increased risk of bleeding and did not prevent thromboembolism. The bleeding risk varied by the type of endoscopic procedure.

中文翻译：

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使用华法林或直接口服抗凝剂的患者的治疗性内窥镜相关胃肠道出血和血栓栓塞事件：来自全国大型数据库分析的结果

目的 比较与华法林和直接口服抗凝剂 (DOAC) 相关的内镜检查后结果的风险，同时考虑肝素桥接和各种类型的内镜手术。设计 使用日本诊断程序组合数据库，我们确定了 2014 年至 2015 年接受 13 种高危内镜手术并服用术前华法林或 DOAC 的 16 977 名患者。进行了一对一倾向评分匹配以比较内镜检查后胃肠道出血华法林组和 DOAC 组之间的血栓栓塞。结果在涉及 5046 对的倾向评分匹配分析中，华法林组的胃肠道出血比例显着高于 DOAC 组（12.0% vs 9.9%；p=0.002）。在血栓栓塞（5.4% vs 4.7%）或住院死亡率（5. 4% 对 4.7%）。与单独接受 DOAC 治疗的患者相比，接受华法林加肝素桥接或 DOAC 加桥接治疗的患者发生胃肠道出血和血栓栓塞的风险更大。与经皮内镜下胃造口术相比，接受内镜下黏膜下剥离术、内镜下黏膜切除术和内镜下静脉曲张结扎术或内镜注射硬化剂等止血手术的患者在 13 种内镜手术中胃肠道出血的风险最高，而接受内镜下息肉切除术的患者发生胃肠道出血的风险最高。括约肌切开术或内窥镜超声引导的细针抽吸处于中等风险。结论 华法林组内镜检查后胃肠道出血的风险高于 DOAC 组。肝素桥接与出血风险增加有关，但不能预防血栓栓塞。出血风险因内窥镜手术类型而异。