Post written by Enrique Rodríguez de Santiago, MD, MSc, from the Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Koto-Ku, Tokyo, Japan, and the Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain.
In this study, we aimed to investigate the safety of peroral endoscopic myotomy (POEM) in patients receiving anticoagulant and/or antiplatelet therapy.
We needed data addressing the safety of the procedure in this population since no studies had evaluated the impact of antitrombotic therapy in POEM outcomes. We felt that this study was pertinent given the increasing number of elderly patients who undergo this procedure, in whom the use of anticoagulants is relatively frequent. Moreover, this study helped to obtain some guidance about the periprocedural management of antithrombotic drugs before and after POEM.
Our main finding is that POEM can be safely conducted in patients receiving antithrombotics, although with a slight increase of major bleeding (5.6% vs 0.8%, P = .03). Additionally, we found that the procedure can be performed without interrupting aspirin and with a short temporary interruption of anticoagulant therapy, similar to what occurs in other high-risk of bleeding endoscopic interventions. Future studies should focus on which measures could reduce the risk of bleeding and how to best manage delayed major bleeding.
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