Effect of Different Types of Antithrombotic Agents on Clinical Outcomes in Patients With Small Bowel Bleeding Who Underwent Balloon-Assisted Enteroscopy: A KASID Multicenter Study

Abstract

Background and aim: The impact of different anti-thrombotic agents on patients with suspected small bowel bleeding (SSBB) who underwent balloon-assisted enteroscopy (DAE) is unclear. We aimed to examine the clinical effects and predictive factors of DAE based on the thromboembolic agents used.

Methods: We enrolled 399 patients with SSBB from a web-based DAE registry across 30 medical centers in South Korea. Among them, 291 patients did not receive anti-thrombotic agents, whereas 80, 22, and 6 patients received anti-platelet agents, direct oral anti-coagulants (DOACs), and warfarin, respectively.

Results: Diagnostic yields were similar across groups; however, therapeutic yields differed: 25.4%, 37.5%, 63.6%, and 83.3% in patients treated with no anti-thrombotic agents, anti-platelets, DOACs, and warfarin, respectively (p < 0.001). The multivariable logistic regression revealed that patients treated with DOACs and warfarin experienced significantly higher therapeutic yields (odds ratio [OR]: 2.803 and 9.526, respectively; 95% confidence interval [CI]: 1.048-7.500 and 1.061-85.481, respectively; p = 0.040 and 0.044, respectively) than those treated with no anti-thrombotic agents. The re-bleeding rates in patients treated with no anti-thrombotic agents, anti-platelets, DOACs, and warfarin were 9.6%, 6.3%, 13.6%, and 50.0%, respectively (p = 0.069). In the multivariable logistic regression analysis, patients treated with warfarin exhibited higher re-bleeding rates than those not treated with anti-thrombotic agents (OR: 9.393, 95% CI: 1.809-48.764, p = 0.008).

Conclusions: The diagnostic yield of DAE did not differ based on the anti-thrombotic agent type, whereas the therapeutic yield of DAE in DOAC and warfarin users was high. Careful monitoring for re-bleeding is advised in DOAC as well as warfarin users.