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• W2978246953 abstract "Introduction: Current endoscopic antiplatelet and anticoagulation management guidelines do not assess the risk associated with bleeding for radiofrequency ablation (RFA) of dysplastic Barrett's Esophagus (BE) due to a paucity of data. While it is thought to be a generally safe procedure with low absolute risk of bleeding, there is insufficient evidence to evaluate the association of bleeding with antiplatelet and anticoagulation use. We seek to evaluate the risk of post-RFA bleeding associated with aspirin, clopidogrel, and warfarin use. Methods: We retrospectively reviewed a prospectively maintained database of endoscopic treatment sessions from 2003-2013 of individuals treated with RFA therapy alone (either circumferentially or focally) for dysplastic BE at our specialized BE Unit. Sessions in which a patient had therapy other than or in addition to RFA including: stricture dilatation, other thermal coagulation, cryotherapy, endoscopic mucosal resection, endoscopic submucosal dissection, strictureplasty, or stenting were excluded. Electronic medical records were reviewed for each RFA session to establish if the respective patient had been taking aspirin, clopidogrel, or warfarin prior to the procedure and to determine whether post-RFA bleeding occurred. It is our practice to hold antiplatelet medications 5-days prior to RFA if tolerated, and to maintain those on warfarin at an INR < 1.5. Results: There were 268 unique patients undergoing treatment for dysplastic BE of which 633 treatment sessions comprised of RFA alone. Only 1 of 633 treatment sessions was associated with post-RFA bleeding (0.2%) and this individual was not on any antiplatelet or anticoagulation therapy. Of the 633 RFA sessions, 333 (52.6%) were performed on aspirin users, 41 (6.5%) on clopidogrel users, and 34 (5.4%) on warfarin users. There were no patients on both aspirin and clopidogrel undergoing RFA therapy in our cohort. Conclusion: RFA therapy for the treatment of dysplastic BE is safe to perform on patients receiving antiplatelet or anticoagulation therapy so long as precautions are undertaken to minimize bleeding risk. We demonstrated 0% post-RFA bleeding for patients on antiplatelet or anticoagulation therapy by withholding antiplatelet agents 5 days prior to RFA therapy and by maintaining anticoagulation at an INR < 1.5 respectively. These precautions can used towards formulating new guideline recommendations for antiplatelet and anticoagulation management surrounding RFA therapy." @default.
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• W2978246953 date "2015-10-01" @default.
• W2978246953 modified "2023-09-26" @default.
• W2978246953 title "Antiplatelet and Anticoagulation Use Does Not Increased the Risk of Bleeding Following Radiofrequency Ablation of Dysplastic Barrettʼs Esophagus" @default.
• W2978246953 doi "https://doi.org/10.14309/00000434-201510001-01513" @default.
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