Safety of Esophageal Dilation Procedures in Patients on Antithrombotic Therapy: A Propensity-Matched Cohort Study.

Introduction: Esophageal dilation procedures are frequently performed on patients who are taking antithrombotic medications. The aim of this study was to evaluate whether patients on antithrombotic therapies have an increased risk of bleeding from esophageal dilation.

Methods: A retrospective propensity-matched cohort study was conducted to evaluate patients in the TriNetX US Collaborative Network database who underwent esophageal dilation procedures. The primary outcome was to assess the effect of anticoagulants and dual-antiplatelet therapies (DAPTs) on the rate of postprocedural gastrointestinal bleeding within 30 days.

Results: Patients on anticoagulants were found to be at higher risk of postprocedural gastrointestinal bleeding compared with patients not on anticoagulants (relative risk [RR], 1.43; 95% confidence interval [CI], 1.06-1.92; P  = 0.017). The anticoagulant group had higher rates of blood transfusion and intensive care unit admission. The DAPT group had a higher rate of gastrointestinal bleeding compared with no antiplatelet therapy, though this did not reach statistical significance (RR, 1.64; 95% CI, 0.97-2.75; P = 0.06). When compared with aspirin monotherapy, the difference in bleeding rates was also not statistically significant (RR, 1.36; 95% CI, 0.84-2.19; P = 0.2). There was no difference in the rates of blood transfusion or intensive care unit admission when DAPT was compared separately with aspirin and with no antiplatelet groups. In addition, early resumption of anticoagulation or antiplatelet therapy was not associated with increased postprocedural bleeding.

Discussion: Patients on anticoagulants at the time of esophageal dilation were at higher risk of postprocedural bleeding. DAPT was numerically associated with a higher risk of bleeding, but this did not reach statistical significance. These findings aim to inform the clinical decision making in preprocedure and postprocedure management of esophageal dilation procedures.