In patients undergoing peroral endoscopic myotomy (POEM) who are receiving antithrombotic therapy, the risk of bleeding and thromboembolic events is unknown. Our primary aim was to assess the safety of POEM in this patient subset. Secondary outcomes assessed were rates of clinical success, gastroesophageal reflux disease (GERD) and procedure-related outcomes.
This was an international, 1:1, case-control study performed at ten centers using prospectively maintained databases. All consecutive patients who underwent POEM before November 2019 were considered for inclusion. Cases were patients on antiplatelet and/or anticoagulant therapy. Controls not receiving antithrombotics were matched for age and esophageal motility disorder. Primary outcomes were major bleeding and thromboembolic events on postprocedural day 30.
Of 2,895 patients undergoing POEM identified, 126 cases (103 on antiplatelets, 35 anticoagulants, 12 both) and 126 controls were enrolled. Major bleeding rate was higher in the antithrombotics users (5.6% vs 0.8%, P = .03). Anticoagulants and clopidogrel were temporarily interrupted in all cases. Aspirin was continued in 40.5% of users without increasing the bleeding risk. One thromboembolic event occurred in each group (0.79%; P = 1.00). No POEM-related deaths were noted. Rates of clinical success (91.7% vs 96% in controls, P = .20), postprocedural GERD and technical-related outcomes were similar in both groups. Antithrombotic management was heterogeneous and guidelines were not adhered to in 23.8% of cases.
POEM is safe and effective in patients receiving antithrombotic therapy although it is associated with a greater risk of major bleeding.
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