TOPLINE:

Patients receiving anticoagulants during esophageal dilation have a notably higher risk for gastrointestinal (GI) bleeding within 30 days post-procedure than those not on anticoagulants, and they also experience higher rates of blood transfusion and ICU admission.

METHODOLOGY:

• Although diagnostic GI endoscopy without intervention typically carries minor bleeding risk and does not require stopping oral antithrombotic medication, bleeding risks specific to dilation procedures remain poorly understood.
• Researchers retrospectively reviewed electronic health record data from patients on various antithrombotic medications who underwent standard balloon or Savary esophageal dilation between January 2000 and April 2025.
• Patients were matched 1:1 with controls: anticoagulant users vs nonusers, dual antiplatelet therapy (DAPT) users to nonusers, and DAPT users to aspirin-only users.
• Anticoagulation therapy included warfarin, rivaroxaban, dabigatran, apixaban, or edoxaban within 1 day of dilation; DAPT included aspirin plus ticagrelor, clopidogrel, or prasugrel within 2 days of dilation.
• The primary outcome was rate of GI bleeding within 30 days of dilation.

TAKEAWAY:

• Researchers matched 2742 anticoagulant users to nonusers, 806 DAPT users to nonusers, and 835 DAPT users to aspirin-only users. Mean ages ranged from 71.2 to 73.5 years, and women comprised 39.5%-47.8%.
• Anticoagulant users had a 1.43-fold higher relative risk (RR) of postprocedural GI bleeding than nonusers, with warfarin showing a notably higher risk (RR, 1.92).
• Anticoagulant users also had higher rates of blood transfusion, ICU admission, and mortality than nonusers (P < .01 for all).
• DAPT use was associated with a higher but not statistically significant rate of GI bleeding compared with no antiplatelet therapy or aspirin alone.
• Time of antithrombotic therapy resumption (early vs delayed) did not significantly increase bleeding risk.

IN PRACTICE:

"Our analysis aligns with the guidelines that recommend discontinuing [anticoagulation] before esophageal dilation procedures due to the high bleeding risk," the authors wrote.

SOURCE:

This study was led by Khaled Elfert, MD, West Virginia University School of Medicine in Morgantown. It was published online in The American Journal of Gastroenterology.

LIMITATIONS:

As a retrospective analysis, the result may be influenced by unaccounted for confounders. Reliance on diagnostic codes may have introduced inaccuracies or omissions. Medication data reflected prescriptions and orders but not confirmed patient use.

DISCLOSURES:

This study received no specific funding. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.