PREDICTIVE FACTORS FOR POST-ERCP BLEEDING. INFLUENCE OF DIRECT ORAL ANTICOAGULANTS.

Introduction We find a rising number of patients receiving antiplatelet and anticoagulation therapy who require endoscopic retrograde cholangiopancreatography (ERCP), probably due to a higher incidence of the increased morbidity of older patients. Considering the increasingly spreading use of direct oral anticoagulants (DOACs), we want to study about the influence of these factors on the possibility of hemorrhage after ERCP in our center. Material and methods We collected data from all the examinations carried out in the years 2017 and 2018, which included 797 examinations on 588 patients. Collected data included: personal history of the patients, results of the test and follow-up. Results In our study, the percentage of post-ERCP bleeding was 4.6% (n=37). With regard to the severity, in 21.6% (n=8) of the cases the bleeding was mild, it was moderate in 59.5% (n=22), and severe in 18.9% (n=7). Previous cardiopathy, antiplatelet therapy, anticoagulation therapy, treatment with DOACs, having a pancreatic stent, and lithiasis removal double the risk of bleeding after ERCP. Having a sphincterotomy represents an over five-fold increase of the risk. Conclusion In the multivariate analysis, we observed a statistically significant increase of bleeding among patients treated with DOACs, compared to patients who receive anticoagulation with acenocoumarol or low-molecular-weight heparins (LMWH).