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The number of patients receiving anticoagulants to prevent cardiovascular and cerebrovascular disease has increased with the aging society worldwide; however, anticoagulants (direct oral anticoagulants [DOACs] and warfarin) are one of the most major risk factors for postprocedure bleeding. This review investigated post\u2010EST bleeding in anticoagulant users, focusing on risk factors, clinical guidelines, pharmacological characteristics, and the future of post\u2010EST bleeding. Several clinical guidelines for antithrombotic drug users have been established to prevent postprocedure bleeding; nevertheless, the risk of bleeding is believed to be several times higher than for nondrug users, regardless of clinical guideline compliance. The major problem in this field is that patients who experience delayed bleeding are often receiving multiple antithrombotic drugs, and no parameters that can accurately monitor the anticoagulant effect of DOACs have been identified. Therefore, identifying patients with a generally high\u2010risk of postprocedure bleeding is crucial. Recently, the plasma level and antifactor Xa activity of factor Xa inhibitors have been investigated in relation to the risk of major bleeding in users. Similar to the prothrombin time\u2010international normalized ratio for warfarin, plasma levels, and antifactor Xa activity may be useful parameters for monitoring the anticoagulant effect and identifying DOAC users at higher risk of postprocedure bleeding, including post\u2010EST bleeding. Future studies should stratify the risk of post\u2010EST delayed bleeding based on a scoring system to prevent this complication.<\/jats:p>","DOI":"10.1111\/den.15016","type":"journal-article","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T04:49:19Z","timestamp":1741150159000},"page":"733-746","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed bleeding after endoscopic sphincterotomy in patients receiving anticoagulants"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9194-7392","authenticated-orcid":false,"given":"Mitsushige","family":"Sugimoto","sequence":"first","affiliation":[{"name":"Division of Genome\u2010Wide Infectious Microbiology, Research Center for GLOBAL and LOCAL Infectious Disease Oita University  Oita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology National Hospital Organization Kyoto Medical Center  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8399-4797","authenticated-orcid":false,"given":"Kento","family":"Shionoya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayoshi","family":"Tsuchiya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9433-8437","authenticated-orcid":false,"given":"Takao","family":"Itoi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Tokyo Medical University Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v25.i27.3468"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5568"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-018-06623-8"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199609263351301"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-017-1347-9"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.12336"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1392408"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.08.016"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-0752-9956"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1499-3872(12)60238-0"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002946"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2023.01.043"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.5946\/ce.2023.013"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.06.051"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2024.05.014"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01563.x"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(91)70740-2"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2009.10.027"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01279.x"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/jcag\/gwae014"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-319926"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09096-y"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5513-1"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i30.5557"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000404"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-313999"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-018-6129-9"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.14764"},{"key":"e_1_2_14_30_1","first-page":"591","article-title":"Predictive factors for post\u2010ERCP bleeding. 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