Do aspirin and non-steroidal anti-inflammatory drugs increase the risk of post-sphincterotomy hemorrhage – A case-control study

SummaryBackground and objectiveNon-steroidal anti-inflammatory drugs (NSAIDs) and aspirin have antiaggregant properties and patients with pancreaticobiliary disease commonly use these drugs. We prospectively investigated whether aspirin and NSAIDs are associated with endoscopic sphincterotomy related hemorrhage.MethodsThree hundred and eight patients who underwent sphincterotomy were sequentially recruited into this prospective case-control study. Pre-endoscopic assessment included a complete blood count, coagulation studies and a detailed drug history after sphincterotomy patients were followed up for bleeding. Cases and controls were compared for patient and procedure-related risk factors of post-endoscopic sphincterotomy bleeding.ResultsHemorrhage occured in 74 (24%) patients. Eight (2.6%) were clinically significant and five (1.6%) were severe. Amongst cases with hemorrhage, 17.6% were on NSAIDs and 14.9% on aspirin; 27.4% of controls took NSAIDs, and 9.8% aspirin (P > 0.05). Aspirin use in patients with significant (12.5%) or severe hemorrhage (20%) was not different from the controls (P > 0.05) and none of them had NSAIDs prior to sphincterotomy. Based on univariate analysis, coagulopathy and comorbidity were risk factors for significant post-sphincterotomy hemorrhage and coagulopathy was the only independent parameter (odds ratio = 22.72, 95% CI [4.25; 125]).ConclusionAspirin and NSAIDs do not increase the risk of post-sphincterotomy hemorrhage and they can be safely used before the procedure.