Document Detail


Abnormal clotting parameters before therapeutic ERCP: do they predict major bleeding?
MedLine Citation:
PMID:  10524637     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A total of 399 consecutive patients undergoing 598 ERCPs (endoscopic retrograde cholangiopancreatographies), including 88 pre-cut papillotomies and 206 conventional papillotomies, are described in a retrospective study. Clotting parameters, haemoglobin levels, indications for pre-cut and/or conventional papillotomy and the use of drugs assumed to interfere with blood clotting (anticoagulants, platelet-aggregation inhibitors, low-molecular-weight heparin) were evaluated in order to detect risk factors for ERCP-associated bleeding. The overall incidence of ERCP-associated bleeding was 18/598 (3.0%). The incidence of bleeding in the group without papillotomy was 7/346 (2.0%). This group consisted of patients who underwent only a diagnostic ERCP, patients who had undergone papillotomy previously, patients in whom a renewed attempt was made to extract biliary stones, and patients in whom removal or change of a stent was necessary. The incidence of papillotomy-associated bleeding was 11/252 (4.4%). Pre-cut papillotomy did and conventional papillotomy did not significantly increase the incidence of bleeding: 15.2% (P < 0.001) and 1.9% (P= 1.00) respectively. The incidence of ERCP-associated bleeding in the group not using any drugs interfering with blood clotting was 2.5%. The use of low-molecular-weight heparin (10.3%) during ERCP significantly increased the risk of bleeding (P= 0.01). However, the use of platelet aggregation inhibitors (2.4%) did not (P= 1.00). As the incidence of bleeding in patients with normal clotting parameters, including the patients with abnormal parameters which were well corrected (4.3%), was higher than in patients with abnormal haemostatic screens (2.7%), abnormal coagulation tests did not predict ERCP-associated bleeding.
Authors:
A Oren; R Breumelhof; R Timmer; D H Biesma; J B Hoekstra
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of gastroenterology & hepatology     Volume:  11     ISSN:  0954-691X     ISO Abbreviation:  Eur J Gastroenterol Hepatol     Publication Date:  1999 Oct 
Date Detail:
Created Date:  1999-12-17     Completed Date:  1999-12-17     Revised Date:  2009-10-16    
Medline Journal Info:
Nlm Unique ID:  9000874     Medline TA:  Eur J Gastroenterol Hepatol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1093-7     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine and Gastroenterology, Diakonessen Hospital, Utrecht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / adverse effects
Blood Coagulation Tests
Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
Hemorrhage / epidemiology*,  etiology
Hemorrhagic Disorders / diagnosis*
Heparin, Low-Molecular-Weight / adverse effects
Humans
Incidence
Intraoperative Complications / epidemiology
Postoperative Complications / epidemiology
Predictive Value of Tests
Retrospective Studies
Risk
Sphincterotomy, Endoscopic / adverse effects*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight

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