B0507 - Esophageal Variceal Ligation in Patients on Anticoagulation and Factors That Affect Post-Procedure Bleeding Risk

Katya Swarts, MD¹, Zachary Henry, MD, MS¹, Shaina H. Hasan, MD¹, Brian J. Wentworth, MD¹, Neeral L. Shah, MD^2
1University of Virginia Health System, Charlottesville, VA; ²University of Virginia, Charlottesville, VA

Introduction: Anticoagulant medication use in patients with cirrhosis has increased in recent years. However, the presence of esophageal varices and necessity of band ligation (EVL) complicates their use. Optimal agents and recommendations for periprocedural management are lacking. To address this deficiency, we aimed to understand specific risk factors associated with post-EVL bleeding events.

Methods: We conducted a single-center retrospective study of patients with either compensated or decompensated cirrhosis undergoing EVL and requiring concurrent periprocedural anticoagulant management from 1/1/2015 - 2/16/2022. Patients with non-cirrhotic portal hypertension were excluded. Information about bleeding events were collected for four weeks after esophageal variceal ligation. Major and minor bleeding events were defined by the International Society on Thrombosis and Haemostasis criteria. Comparative statistics were performed using the Fisher exact test and Wilcoxon test.

Results: Forty seven procedures were identified that met inclusion criteria. Of those, there were six bleeding events (12.7%) including three from post banding ulcers, one from EV rebleed, and two from PHG/GAVE. Bleeding events occurred between 5-20 days post procedure. Bleeding events were associated patients with more severe liver disease, as represented by higher mean MELD-Na (24 vs. 12, p< 0.01) and Child-Pugh score (11 vs. 7 (p< 0.01). Bleeding events were not associated with timing of pre-procedural anticoagulation discontinuation (p=0.30), timing of anticoagulation initiation or resumption (p=0.60), type of anticoagulant (DOAC vs. other, p=0.60), subtherapeutic dosing (p=1.00), or the presence of high-risk esophageal varices (p=0.60).

Discussion: We found that bleeding events were not associated with the timing of starting or resuming anticoagulation, type of anticoagulation, subtherapeutic dosing, or high-risk esophageal varices. Rather, bleeding was associated only with severity of liver disease. Our results may help inform recommendations for EVL periprocedural anticoagulation management. Further research involving multiple centers and a larger sample size is needed to more fully characterize the risk factors for bleeding post-EVL.



Disclosures:


Katya Swarts, MD¹, Zachary Henry, MD, MS¹, Shaina H. Hasan, MD¹, Brian J. Wentworth, MD¹, Neeral L. Shah, MD². B0507 - Esophageal Variceal Ligation in Patients on Anticoagulation and Factors That Affect Post-Procedure Bleeding Risk, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.