S1288 Comparative Safety of Anticoagulants and Antiplatelet Agents in Upper GI Endoscopic Dilation Procedures

Introduction: Upper gastrointestinal endoscopic dilation is commonly performed for benign strictures, but it carries a risk of complications such as bleeding. The use of anticoagulant (AC) or antiplatelet (AP) therapy may increase this risk, yet data on their safety in this context remain limited. Methods: An analysis using TriNetX was conducted to compare outcomes between patients on anticoagulant (AC) therapy (e.g., warfarin, DOACs) and those on antiplatelet (AP) agents (e.g., aspirin, clopidogrel) within 7 days of undergoing upper gastrointestinal endoscopic dilation. A total of 4,226 AC patients and 14,878 AP patients were identified. Patients were propensity-matched 1:1 based on demographics and key clinical variables, resulting in 4,103 matched pairs. The primary outcomes assessed within 30 days post-procedure were gastrointestinal (GI) bleeding, transfusion, and hospitalization. Results: GI bleeding was more frequent among AC users (15.3%) compared to AP users (11.7%). Similarly, transfusion requirements were higher in the AC group (18.6% vs 12.9%). Kaplan-Meier survival curves and risk analyses indicated a statistically significant increase in post-procedure complications in patients on anticoagulation compared to those on antiplatelet therapy. Conclusion: Our study aimed to evaluate the risk of gastrointestinal bleeding and related outcomes following upper GI endoscopic dilation in patients on anticoagulant or antiplatelet therapy compared to non-users. We found that medication users had a significantly higher risk of GI bleeding, emphasizing the need for cautious peri-procedural planning in this population.