Background: 

Several professional society guidelines suggest holding antiplatelet agents before high-risk procedures. However, there is lack of high-grade evidence to support the recommendation as most of the studies have been single center with small sample sizes. We aimed to perform the first systematic review and meta-analysis comparing dual antiplatelet therapy (DAPT) versus aspirin alone in terms of postendoscopic retrograde cholangiopancreatography (ERCP) bleeding.

Methods 

Three independent reviewers performed a comprehensive review of all original articles published from inception to May 2020, evaluating the post-ERCP bleeding rate in setting of DAPT. Primary outcomes were the overall post-ERCP bleeding rate with the use of dual antiplatelet therapy; comparison of post-ERCP bleeding rate in patients with DAPT versus aspirin alone. Secondary outcomes were comparison of immediate and delayed post-ERCP bleeding outcomes in the 2 cohorts.

Results: 

Six studies were included after a thorough search was concluded using the key words. The pooled analysis of studies revealed an overall post-ERCP bleeding rate of 5.7% (95% confidence interval: 3-10.6) on sustained DAPT. Post-ERCP bleeding in DAPT Cohort was not significantly higher as compared with aspirin only Cohort (odds ratio: 1.14, 95% confidence interval: 0.46-2.81). The immediate bleeding and delayed bleeding rates cannot be generalized due to low number of studies.

Conclusions: 

The first systematic review and meta-analysis showed that post-ERCP bleeding rates are not significantly higher in DAPT cohort as compared with aspirin alone. Therefore, the risk of bleeding is less likely related to the antiplatelet agents and more likely related to the procedure itself.

中文翻译：

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双联抗血小板药物与单用阿司匹林的 ERCP 术后出血率没有显着差异：系统评价和荟萃分析

背景： 

一些专业协会指南建议在高风险手术前服用抗血小板药物。然而，由于大多数研究都是单中心且样本量较小，因此缺乏高级证据支持该建议。我们的目的是进行首次系统评价和荟萃分析，比较双联抗血小板治疗（DAPT）与单用阿司匹林治疗内镜逆行胰胆管造影（ERCP）后出血的情况。

方法 

三名独立评审员对从开始到 2020 年 5 月发表的所有原始文章进行了全面评审，评估了 DAPT 背景下的 ERCP 后出血率。主要结局是使用双联抗血小板治疗的 ERCP 后总体出血率；DAPT 患者与单用阿司匹林患者 ERCP 后出血率的比较。次要结局是 2 个队列中 ERCP 后立即和延迟出血结局的比较。

结果： 

使用关键词进行彻底搜索后，纳入了六项研究。研究汇总分析显示，持续 DAPT 后 ERCP 后总体出血率为 5.7%（95% 置信区间：3-10.6）。与仅使用阿司匹林的队列相比，DAPT 队列的 ERCP 后出血并未显着升高（比值比：1.14，95% 置信区间：0.46-2.81）。由于研究数量较少，无法概括即刻出血率和延迟出血率。

结论： 

首次系统评价和荟萃分析表明，与单独使用阿司匹林相比，DAPT 队列中 ERCP 后出血率并没有显着升高。因此，出血风险不太可能与抗血小板药物有关，而更有可能与手术本身有关。