{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T17:00:41Z","timestamp":1784739641655,"version":"3.55.0"},"reference-count":27,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digestion"],"abstract":"<jats:p>Introduction: Optimal management of antithrombotic drugs (ATDs) is essential to minimize bleeding during high-risk endoscopic procedures. This study aimed to investigate periprocedural ATD strategies to reduce 30-day post-procedural bleeding. Methods: We performed a multicenter, retrospective cohort study on high-risk endoscopic procedures. The primary outcome was 30-day bleeding requiring endoscopic hemostasis. We categorized the peri-procedure management of ATDs into continuation, discontinuation, and replacement. We evaluated the risk differences in 30-day bleeding among ATD management groups, as compared to patients who did not take ATDs (nonusers). Results: High-risk upper-GI procedures included 1,365 esophageal ESDs, 788 elective EVLs, 5,391 gastric ESDs, and 2,562 PEGs; lower-GI procedures included 23,326 colonic polypectomy\/EMRs and 2,769 colonic ESDs. ATD management included aspirin continuation (n = 818) and discontinuation (n = 62); thienopyridine discontinuation (n = 188) and replacement (n = 97); warfarin continuation (n = 97) and discontinuation (n = 20); DOAC discontinuation (n = 487). Thirty-day bleeding occurred in 5.89% of upper-GI and 1.22% of lower-GI procedures. Bleeding risk differed according to ATD management. In upper-GI procedures, numerically higher bleeding rates were observed in some antithrombotic management groups, particularly aspirin continuation and thienopyridine discontinuation during gastric ESD, compared with nonusers; however, the absolute risk differences were within 10%. In contrast, bleeding risk differences in lower-GI procedures were smaller overall and within 5%. Conclusion: This multicenter study describes differential bleeding risk patterns across high-risk endoscopic procedures among patients receiving antithrombotic therapy.<\/jats:p>","DOI":"10.1159\/000552539","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T16:00:53Z","timestamp":1779206453000},"page":"1-11","source":"Crossref","is-referenced-by-count":0,"title":["Association between Antithrombotic Drug Management and Bleeding during High-Risk Endoscopic Procedures: A Multicenter Retrospective Observational 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