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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2020; 12(11): 408-450
Published online Nov 16, 2020. doi: 10.4253/wjge.v12.i11.408
Table 1 Diagnostic endoscopy and colonoscopy with biopsy
Ref. Year Country Study design n Procedure Medication Relative risk Fujita et al [5 ] 2015 Japan Retrospective 3671 Endoscopic biopsy No medications Incidence of PPB 0.98% Ara et al [6 ] 2015 Japan Prospective 3758 Endoscopic biopsy No medications Incidence of PPB 0.12% Yuki et al [7 ] 2017 Japan Prospective 263 Endoscopic biopsy No medications No incidence of PPB
Table 2 Diagnostic ± therapeutic push or device assisted enteroscopy/balloon enteroscopy
Ref. Year Country Study design n Procedure Medication Relative risk Yamamoto et al [8 ] 2015 Japan Prospective 120 DBE No medications No incidence of PPB Wang et al [9 ] 2020 Japan Retrospective 1531 DBE No medications Incidence of PPB 0.5%
Table 3 Endoscopic ultrasound ± fine needle aspiration
Ref. Year Country Study design n Procedure Medication Relative risk Song et al [18 ] 2010 South Korea Prospective 117 EUS + FNA No medications No incidence of PPB Uehara et al [10 ] 2011 Japan Retrospective 115 EUS + FNA No medications No incidence of PPB Suzuki et al [11 ] 2012 United States Prospective 20 EUS + FNA No medications No incidence of PPB Lee et al [12 ] 2013 South Korea Prospective 188 EUS + FNA No medications Incidence of PPB 2.1% (25G group). Incidence of PPB 4.3% (22G group) Vilmann et al [13 ] 2013 Denmark Prospective 135 EUS - FNA No medications No incidence of PPB Yang et al [14 ] 2015 South Korea Retrospective 76 EUS + FNA No medications No incidence of PPB Mavrogenis et al [15 ] 2015 United States Prospective 28 EUS + FNA No medications No incidence of PPB Ramesh et al [19 ] 2015 South Korea Prospective 100 EUS + FNA No medications No incidence of PPB. Incidence of immediate/intraprocedural bleeding 1.0% Park et al [16 ] 2016 Denmark Prospective 56 EUS + FNA No medications No incidence of PPB Inoue et al [17 ] 2017 Japan Retrospective 742 EUS + FNA No medications No incidence of PPB Iwashita et al [20 ] 2018 South Korea Prospective 110 EUS + FNA No medications No incidence of PPB. Incidence of immediate/intraprocedural bleeding 1.8%
Table 4 Endoscopic retrograde cholangiopancreatography (diagnostic)
Ref. Year Country Study design n Procedure Medication Relative risk Masci et al [21 ] 2001 Italy Prospective 782 ERCP (diagnostic) No medications Incidence of PPB 1.13% Williams et al [22 ] 2007 United Kingdom Prospective 5264 ERCP (diagnostic) No medications Incidence of PPB 0.9% Cotton et al [23 ] 2009 United States Retrospective 11497 ERCP (diagnostic) No medications Incidence of PPB 0.3% Coelho-Prabhu et al [24 ] 2013 United States Retrospective 1072 ERCP (diagnostic) No medications Incidence of PPB 1.4% Rotundo et al [25 ] 2020 United States Retrospective 555 ERCP (diagnostic) No medications Incidence of PPB 1.66% (teaching hospital). Incidence of PPB 1.49% (nonteaching hospital)
Table 5 Conventional polypectomy/hot snare polypectomy
Ref. Year Country Study design n Procedure Medication Relative risk Gupta et al [26 ] 2012 United Kingdom Prospective 1200 Polypectomy No medications Incidence of PPB 0.67% Paspatis et al [27 ] 2011 Greece Prospective 18 Polypectomy No medications No incidence of PPB Singh et al [28 ] 2010 United States Retrospective 1243 Polypectomy No medications Incidence of PPB 1% Sewitch et al [29 ] 2012 Canada Prospective 2134 Polypectomy No medications Incidence of PPB 0.05% Feagins et al [30 ] 2011 United States Retrospective 1849 Polypectomy No medications Incidence of PPB 0.32% Pan et al [31 ] 2012 New Zealand Retrospective 348 Polypectomy No medications Incidence of PPB 0.86% Manocha et al [32 ] 2012 United States Retrospective 672 Polypectomy No medications Incidence of PPB 3.0% Kim et al [33 ] 2013 South Korea Retrospective 7447 Polypectomy No medications Incidence of PPB 1.3% Gavin et al [34 ] 2013 United States Prospective 20085 Polypectomy No medications Incidence of PPB 0.26% Rutter et al [35 ] 2014 United Kingdom Retrospective 167208 Polypectomy No medications Incidence of PPB 0.65% Choung et al [36 ] 2014 South Korea Retrospective 5981 Polypectomy No medications Incidence of PPB 1.1% Gómez et al [37 ] 2015 United States Prospective 18 Polypectomy No medications No incidence of PPB Suzuki et al [38 ] 2018 Japan Prospective 27 Polypectomy No medications No incidence of PPB. Incidence of immediate/intraprocedural bleeding 3.5% Kawamura et al [39 ] 2018 Japan Prospective 402 Polypectomy No medications Incidence of PPB 0.5% Ket et al [40 ] 2020 Australia Retrospective 258 Polypectomy No medications Incidence of PPB 3.5% Kishida et al [41 ] 2019 Japan Retrospective 5381 Polypectomy No medications Incidence of PPB 0.7%
Table 6 Cold snare polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Paspatis et al [27 ] 2011 Greece Prospective 530 Polyp size 3-8 mm CSP No medications No incidence of PPB. Incidence of immediate/intraprocedural bleeding 9.1% Ichise et al [44 ] 2011 Japan Prospective 101 Polyp size < 8 mm CSP No medications No incidence of PPB Gómez et al [37 ] 2015 United States Prospective 21 Polyp size < 6 mm CSP No medications No incidence of PPB Choksi et al [51 ] 2015 United States Retrospective 15 Polyp size ≥ 10 mm CSP No medications No incidence of PPB Muniraj et al [52 ] 2015 United States Retrospective 12 Polyp size ≥ 10 mm CSP No medications No incidence of PPB Piraka et al [53 ] 2017 United States Retrospective 94 Polyp size ≥ 10 mm CSP No medications No incidence of PPB Hirose et al [54 ] 2017 Japan Retrospective 125 Polyp size ≥ 10 mm CSP No medications No incidence of PPB Tutticci et al [55 ] 2018 Australia Prospective 163 Polyp size ≥ 10 mm CSP No medications No incidence of PPB Zhang et al [48 ] 2018 China Prospective 212 Polyp size 6-9 mm CSP No medications No incidence of PPB. Incidence of immediate/intraprocedural bleeding 2.7% Suzuki et al [38 ] 2018 Japan Prospective 25 Polyp size ≤ 10 mm CSP No medications No incidence of PPB Kawamura et al [39 ] 2018 Japan Prospective 394 Polyp size 4-9 mm CSP No medications No incidence of PPB. Incidence of immediate/intraprocedural bleeding 7.1% Ket et al [40 ] 2020 Australia Retrospective 346 Polyp size 10-20 mm CSP No medications No incidence of PPB
Table 7 Endoscopic mucosal resection
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Zhang et al [48 ] 2018 China Prospective 203 Polyp size 6-9 mm EMR No medications No incidence of PPB. Incidence of immediate/intraprocedural bleeding 1.7% So et al [50 ] 2019 South Korea Retrospective 798 Mean polyp size 34 mm EMR No medications Incidence of PPB 6.3% Kim et al [49 ] 2019 South Korea Retrospective 717 Polyp size ≥ 6 mm to < 20 mm EMR No medications Incidence of PPB 1.7%
Table 8 Endoscopic submucosal dissection
Ref. Year Country Study design n Procedure Medication Relative risk Igarashi et al [56 ] 2017 Japan Retrospective 722 Gastric ESD No medications Incidence of PPB 4.2% Sato et al [57 ] 2017 Japan Retrospective 2488 Gastric ESD No medications Incidence of PPB 3.9% Kono et al [58 ] 2018 Japan Retrospective 814 Gastric ESD No medications Incidence of PPB 5.3% Arimoto et al [59 ] 2018 Japan Retrospective 783 Colorectal ESD No medications Incidence of PPB 3.3% Yamashita et al [60 ] 2018 Japan Retrospective 698 Colorectal ESD No medications Incidence of PPB 2.7% Harada et al [61 ] 2020 Japan Retrospective 286 Colorectal ESD No medications Incidence of PPB 6.6% Manta et al [62 ] 2020 Italy Retrospective 296 Gastric ESD No medications Incidence of PPB 10.1% Chen et al [63 ] 2020 China Retrospective 82 Gastric ESD No medications Incidence of PPB 3.7%
Table 9 Endoscopic retrograde cholangiopancreatography with sphincterotomy
Ref. Year Country Study design n Procedure Medication Relative risk Freeman et al [64 ] 1996 United States and Canada Prospective 2347 ERCP + sphincterotomy No medications Incidence of PPB 2% Masci et al [21 ] 2001 Italy Prospective 1662 ERCP + sphincterotomy No medications Incidence of PPB 0.7%. Incidence of immediate PPB 1.1% Tzovaras et al [65 ] 2012 Greece Prospective 50 ERCP + sphincterotomy No medications Incidence of PPB 2% Patai et al [66 ] 2014 Hungary Prospective 242 ERCP + sphincterotomy No medications Incidence of delayed PPB 6.3%. Incidence of immediate/intraprocedural bleeding 2.7% Tanaka et al [67 ] 2015 Japan Prospective 360 ERCP + sphincterotomy No medications Incidence of PPB 9.9% Ikarashi et al [68 ] 2017 Japan Retrospective 816 ERCP + sphincterotomy No medications Incidence of PPB 2.2% Bae et al [69 ] 2019 South Korea Retrospective 1121 ERCP + sphincterotomy No medications Incidence of delayed PPB 1.2%. Incidence of immediate/intraprocedural PPB 8.5% Lima et al [70 ] 2020 Brazil Prospective 2137 ERCP + sphincterotomy No medications Incidence of PPB 2.2% Yan et al [71 ] 2020 China Retrospective 8477 ERCP + sphincterotomy No medications Incidence of PPB 1.6%
Table 10 Ampullectomy
Ref. Year Country Study design n Procedure Medication Relative risk Hopper et al [72 ] 2010 Australia Prospective 10 Ampullectomy No medications Incidence of PPB 30% Harano et al [73 ] 2011 Japan Retrospective 28 Ampullectomy No medications Incidence of PPB 18% Patel et al [74 ] 2011 United States Retrospective 38 Ampullectomy No medications Incidence of PPB 5.3% Salmi et al [75 ] 2012 France Prospective 61 Ampullectomy No medications Incidence of PPB 4.9% Laleman et al [76 ] 2013 Belgium Retrospective 91 Ampullectomy No medications Incidence of PPB 12.1% Attila et al [77 ] 2018 Turkey Retrospective 44 Ampullectomy No medications Incidence of PPB 6.8% Van Der Wiel et al [78 ] 2019 Netherlands Retrospective 87 Ampullectomy No medications Incidence of PPB 12.6% Alali et al [79 ] 2020 Canada Retrospective 103 Ampullectomy No medications Incidence of PPB 21.4%
Table 11 Endoscopic dilatation
Ref. Year Country Study design n Procedure Medication Relative risk Schoepfer et al [80 ] 2010 United States Prospective 207 Dilatation (EoE) No medications No incidence of PPB Ally et al [81 ] 2013 United States Retrospective 66 Dilatation (EoE) No medications No incidence of PPB Jung et al [82 ] 2011 South Korea Retrospective 293 Dilatation (EoE) No medications Incidence of PPB 0.3% Dellon et al [83 ] 2010 United States Retrospective 70 Dilatation (EoE) No medications No incidence of PPB
Table 12 Colonic stenting
Ref. Year Country Study design n Procedure Medication Relative risk Meisner et al [85 ] 2011 Denmark Prospective 439 Colonic stent No medications Incidence of PPB 0.5% van Hooft et al [86 ] 2011 Netherlands Prospective 47 Colonic stent No medications No incidence of PPB Yoon et al [87 ] 2011 South Korea Retrospective 373 Colonic stent No medications Incidence of PPB 0.3% Gianotti et al [88 ] 2013 Italy Prospective 81 Colonic stent No medications Incidence of PPB 3.7%
Table 13 Enteral stenting
Ref. Year Country Study design n Procedure Medication Relative risk Costamagna et al [89 ] 2012 Italy Prospective 202 Duodenal stent No medications Incidence of PPB 3%
Table 14 Oesophageal stenting
Ref. Year Country Study design n Procedure Medication Relative risk Oh et al [90 ] 2014 South Korea Retrospective 1485 Oesophageal stent No medications Incidence of PPB 1.7% Liu et al [91 ] 2016 China Retrospective 519 Oesophageal stent No medications Incidence of PPB 10.4%
Table 15 Endoscopic cystogastrostromy
Ref. Year Country Study design n Procedure Medication Relative risk Varadarajulu et al [92 ] 2008 United States Retrospective 20 ECG No medications No incidence of PPB Melman et al [97 ] 2009 United States Prospective 45 ECG No medications Incidence of PPB 4.4% Johnson et al [93 ] 2009 United States Retrospective 24 ECG No medications Incidence of PPB 8.3% Varadarajulu et al [96 ] 2013 United States Prospective 20 ECG No medications No incidence of PPB Saul et al [94 ] 2016 United States Retrospective 21 ECG No medications Incidence of PPB 9.5% Saluja et al [95 ] 2019 India Retrospective 35 ECG No medications Incidence of PPB 2.9%
Table 16 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion
Ref. Year Country Study design n Procedure Medication Relative risk Singh et al [98 ] 2012 United States Retrospective 1541 PEG No medications Incidence of PPB 2.7% Lozoya-González et al [99 ] 2012 Mexico Retrospective 40 PEG No medications No incidence of PPB
Table 17 Diagnostic endoscopy and colonoscopy with biopsy
Ref. Year Country Study design n Procedure Medication Relative risk Whitson et al [103 ] 2011 United States Prospective 280 Endoscopic biopsy Aspirin (continued) Incidence of bleeding 0.4% Ono et al [104 ] 2012 Japan Prospective 101 Endoscopic biopsy Aspirin (continued) No Incidence of PPB Ara et al [6 ] 2015 Japan Prospective 3758 Endoscopic biopsy Aspirin (continued) No incidence of PPB Fujita et al [5 ] 2015 Japan Retrospective 105 Endoscopic biopsy Aspirin (continued) Incidence of PPB 0.95% Yuki et al [7 ] 2017 Japan Prospective 560 Endoscopic biopsy Aspirin (continued) No incidence of PPB Kono et al [105 ] 2017 Japan Prospective 221 Endoscopic biopsy Aspirin (continued) No incidence of PPB
Table 18 Endoscopic ultrasound ± fine needle aspiration
Ref. Year Country Study design n Procedure Medication Relative risk Inoue et al [17 ] 2017 Japan Retrospective 742 EUS + FNA Aspirin either:(1) Continued (high-risk conditions); (2) Ceased 3 d before No incidence of PPB Kawakubo et al [106 ] 2018 Japan Prospective 85 EUS + FNA Aspirin(continued) No incidence of PPB
Table 19 Polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Pan et al [31 ] 2012 New Zealand Retrospective 145 Size: 2-40 mm (average size 9.6 mm) Polypectomy Aspirin (continued) Incidence of PPB 5.5% Manocha et al [32 ] 2012 United States Retrospective 502 Size: 2-50 mm Polypectomy Aspirin (continued) Incidence of PPB 3.2% Park et al [43 ] 2018 South Korea Prospective 3887 Size: < 10 mm and ≥ 10 mm Polypectomy Aspirin (ceased 5-7 d before and restarted 1 d after) Incidence of PPB 3.4% Lin et al [107 ] 2018 United States Retrospective 20374 Size: < 20 mm and ≥ 20 mm Polypectomy Aspirin (continuation or cessation N/S) Incidence of PPB 0.92% Kishida et al [41 ] 2019 Japan Retrospective 12876 Size: < 10 mm and ≥ 10 mm Polypectomy Aspirin either: (1) Ceased 3-5 d before (cases before 2012); (2) Continued (cases after 2012) Incidence of PPB 0.6% Amato et al [108 ] 2019 Italy Prospective 1504 Size: ≥ 10 mm Polypectomy Aspirin (ceased up to 9 d before) Incidence PPB 4.2% Watanabe et al [109 ] 2020 Japan Retrospective 1050 Size: < 10 mm and ≥ 10 mm Polypectomy Aspirin (continued) Incidence of PPB 4.3%
Table 20 Cold snare polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Makino et al [110 ] 2018 Japan Prospective 33 Size: ≤ 10 mm CSP Aspirin (continued) No incidence of PPB Arimoto et al [111 ] 2019 Japan Retrospective 501 Size: ≤ 10 mm CSP Aspirin (continued) No incidence of PPB. Incidence of immediate/intraprocedural bleeding 9.8% Won et al [112 ] 2019 South Korea Prospective 43 Size: ≤ 10mm CSP Aspirin (continued) No incidence of PPB. Incidence of immediate/intraprocedural bleeding 2.2%
Table 21 Endoscopic mucosal resection
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Ono et al [113 ] 2019 Japan Retrospective 1734 Size: Median size 8.5-9.5 ± 5 mm EMR Aspirin (continuation or ceased 3 d before) Incidence of PPB per polyp resection 1.35% (P = 0.81) on antiplatelet therapy (study limited by not differentiating between aspirin vs thienopyridine) So et al [50 ] 2019 South Korea Retrospective 399 Size: Mean lesion size 34 mm EMR Aspirin (ceased day of procedure or 0-4 d before or ceased 5-7 d before or ceased 8-14 d before procedure) Incidence of PBB 8.2% (either aspirin or thienopyridine monotherapy) Albéniz et al [114 ] 2020 Spain Prospective 1034 Size: ≥ 20 mm (mean size 30.5 mm) EMR Aspirin (cessation dependent on comorbidities) Study expressed risk of PPB on antiplatelet monotherapy as OR: 2.51, 95%CI: 0.99-6.34, P < 0.001 (either aspirin or thienopyridine monotherapy)
Table 22 Endoscopic submucosal dissection
Ref. Year Country Study design n Procedure Medication Relative risk Igarashi et al [56 ] 2017 Japan Retrospective 367 Gastric ESD Aspirin (continued) Incidence of PPB 12.1% Furuhata et al [115 ] 2017 Japan Retrospective 15 Gastric ESD Aspirin (continued or ceased 3-5 d before) Incidence of PPB 6.7% Sato et al [57 ] 2017 Japan Retrospective 211 Gastric ESD Aspirin (continued) Incidence of PPB 5.7% Kono et al [58 ] 2018 Japan Retrospective 23 Gastric ESD Aspirin (continued) Incidence of PPB 21.7% Arimoto et al [59 ] 2018 Japan Retrospective 26 Colorectal ESD Aspirin (continued) No incidence of PPB Oh et al [116 ] 2018 South Korea Retrospective 94 Gastric ESD Aspirin either: (1) Ceased 0-4 d before; (2) Ceased 5-7 d before Incidence of PPB 12.8% Harada et al [117 ] 2019 Japan Retrospective 56 Gastric ESD Aspirin (continued) Incidence of PPB 10.7% Nam et al [118 ] 2019 South Korea Retrospective 31 Gastric ESD Aspirin (ceased 7 d before) Incidence of PPB 22.6% Horikawa et al [119 ] 2019 Japan Retrospective 50 Gastric ESD Aspirin (continued) Incidence of PPB 2.0%
Table 23 Endoscopic retrograde cholangiopancreatography with sphincterotomy
Ref. Year Country Study design n Procedure Medication Relative risk Onal et al [120 ] 2013 Turkey Prospective 35 Sphincterotomy Aspirin (within 24 h) Incidence of PPB 10% Patai et al [66 ] 2014 Hungary Prospective 87 Sphincterotomy Aspirin (continued) Incidence of delayed PPB 5.8%. Incidence of immediate/intraprocedural bleeding 4.6% Ikarashi et al [68 ] 2017 Japan Retrospective 1113 Sphincterotomy Aspirin (continued) Incidence of PPB 1.8% Oh et al [121 ] 2018 United States Prospective 256 Sphincterotomy Aspirin (continued) Incidence of PPB 4.7% Yamamiya et al [122 ] 2019 Japan Retrospective 76 Sphincterotomy Aspirin either: (1) Continued (low-risk conditions); (2) Ceased 3-5 d before (high-risk conditions) No incidence of PPB in either continuous or cessation group
Table 24 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion
Ref. Year Country Study design n Procedure Medication Relative risk Richter et al [124 ] 2011 United States Retrospective 990 PEG Aspirin (continued) Incidence of PPB: (1) ≤ 48 h post-PEG 2.2%; (2) > 48 h post-PEG 1.7% Singh et al [98 ] 2012 United States Retrospective 1541 PEG Aspirin (continued) Incidence of PPB 3.9% Lozoya-González et al [99 ] 2012 Mexico Retrospective 27 PEG Aspirin (ceased 1-3 d before) No incidence of PPB Lee et al [123 ] 2013 South Korea Retrospective 151 PEG Aspirin (continued) No incidence of PPB
Table 25 Diagnostic endoscopy and colonoscopy with biopsy
Ref. Year Country Study design n Procedure Medication Relative risk Whitson et al [103 ] 2011 United States Prospective 350 Endoscopic biopsy Thienopyridine (continued) No incidence of PPB Ono et al [104 ] 2012 Japan Prospective 101 Endoscopic biopsy Thienopyridine (continued) No incidence of PPB Ara et al [6 ] 2015 Japan Prospective 3758 Endoscopic biopsy Thienopyridine either: (1) Continued; (2) Ceased 5-7 d before No incidence of PPB in either group Fujita et al [5 ] 2015 Japan Retrospective 28 Endoscopic biopsy Thienopyridine (continued) No incidence of PPB Yuki et al [7 ] 2017 Japan Prospective 560 Endoscopic biopsy Thienopyridine (continued) No incidence of PPB Kono et al [105 ] 2017 Japan Prospective 221 Endoscopic biopsy Thienopyridine (continued) No incidence of PPB
Table 26 Endoscopic ultrasound ± fine needle aspiration
Ref. Year Country Study design n Procedure Medication Relative risk Inoue et al [17 ] 2017 Japan Retrospective 742 EUS + FNA Thienopyridines (ceased 5 d before) No incidence of PPB Kawakubo et al [106 ] 2018 Japan Prospective 30 EUS + FN Thienopyridines (ceased 5 d before) No incidence of PPB
Table 27 Polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Singh et al [28 ] 2010 United States Retrospective 142 Size: < 5 mm or ≥ 10 mm Polypectomy Thienopyridine (continued) Incidence of PPB 3.5% Feagins et al [30 ] 2011 United States Retrospective 118 Size: < 20 mm and > 20 mm (average 7 mm) Polypectomy Thienopyridine (continued) No incidence of PPB Feagins et al [125 ] 2013 United States Prospective 219 Size: Average 5.2 mm Polypectomy Thienopyridine (continued) Incidence of PPB 2.4% Lin et al [107 ] 2018 United States Retrospective 20374 Size: < 20 mm or ≥ 20 mm Polypectomy Thienopyridine (ceased 5-7 d before) Incidence of PPB 0.84% Kishida et al [41 ] 2019 Japan Retrospective 12876 Size: < 10 mm or ≥ 10 mm Polypectomy Thienopyridine (ceased 5-7 d before) Incidence of PPB 0.6% Amato et al [108 ] 2019 Italy Prospective 1648 Size: ≥ 10 mm Polypectomy Thienopyridine (ceased 6 d before) Incidence of PPB 4.2% Chan et al [126 ] 2019 China (Hong Kong) Prospective 216 Size: < 10 mm or ≥ 10 mm (mean size 4.7 mm) Polypectomy Thienopyridine (continued) Incidence of PPB 3.8% Yu et al [127 ] 2019 United States Retrospective 6443 N/S Polypectomy Thienopyridine (cessation timing N/S) Incidence of PPB 0.9% Watanabe et al [109 ] 2020 Japan Retrospective 45 Size: < 10 mm or ≥ 10 mm Polypectomy Thienopyridine (cessation timing N/S) Incidence of PPB 6.7%
Table 28 Cold snare polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Makino et al [110 ] 2018 Japan Prospective 24 Size: ≤ 10 mm CSP Thienopyridine (continued) No incidence of PPB Arimoto et al [111 ] 2019 Japan Retrospective 516 Size: ≤ 10 mm CSP Thienopyridine (continued) No incidence of PPB
Table 29 Endoscopic mucosal resection
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Ono et al [113 ] 2019 Japan Retrospective 1734 Size: Median size 8.5-9.5 ± 5 mm EMR Thienopyridines (ceased 3-5 d before) Incidence of PPB 1.35% So et al [50 ] 2019 South Korea Retrospective 399 Size: Mean lesion size 34 mm EMR (and ESD) Thienopyridines either: (1) Ceased day of procedure; (2) 0-4 d before; (3) Ceased 5-7 d before; (4) Ceased 8-14 d before Incidence of PBB 8.2% Albéniz et al [114 ] 2020 Spain Prospective 1034 Size: ≥ 20 mm (mean size 30.5 mm) EMR Thienopyridines (ceased 5 d before) Study expressed risk of PPB on antiplatelet monotherapy as OR: 2.51, 95%CI: 0.99-6.34, P < 0.001 (either aspirin or thienopyridine monotherapy)
Table 30 Endoscopic submucosal dissection
Ref. Year Country Study design n Procedure Medication Relative risk Igarashi et al [56 ] 2017 Japan Retrospective 90 Gastric ESD Thienopyridines either: (1) Continued until day of; (2) Ceased 3-7 d before Incidence of PPB 5.6% (continued). Incidence of PPB 12.5% (ceased) Ono et al [128 ] 2017 Japan Prospective 10 Gastric ESD Thienopyridines (continued) Incidence of PPB 20% Sato et al [57 ] 2017 Japan Retrospective 19 Gastric ESD Thienopyridines(ceased 5-7 d before) No incidence of PPB Oh et al [116 ] 2018 South Korea Retrospective 56 Gastric ESD Thienopyridines either: (1) Ceased 0-4 d before; (2) Ceased 5-7 d before Incidence of PPB 3.6% Nam et al [118 ] 2019 South Korea Retrospective 31 Gastric ESD Thienopyridines(ceased 7 d before) Incidence of PPB 19.4%
Table 31 Endoscopic retrograde cholangiopancreatography with sphincterotomy
Ref. Year Country Study design n Procedure Medication Relative risk Patai et al [66 ] 2014 Hungary Prospective 29 Sphincterotomy Thienopyridine (continued) Incidence of delayed PPB 3.5%. Incidence of immediate/intraprocedural bleeding 3.5% Ikarashi et al [68 ] 2017 Japan Retrospective 1113 Sphincterotomy Thienopyridine (ceased 5-7 d before) Incidence of delayed PPB 3.0%. (study categorised cessation of thienopyridine, warfarin and DOAC into the same “discontinuation” group) Yamamiya et al [122 ] 2019 Japan Retrospective 76 Sphincterotomy Thienopyridine (either continued or ceased 5-7 d or switched to aspirin monotherapy before) No incidence of PPB in either continuous or cessation group
Table 32 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion
Ref. Year Country Study design n Procedure Medication Relative risk Richter et al [124 ] 2011 United States Retrospective 990 PEG Thienopyridines(continued) No incidence of PPB ≤ 48 h post-PEG. Incidence of PPB > 48 h post-PEG 4% Singh et al [98 ] 2012 United States Retrospective 143 PEG Thienopyridines (ceased on average 2.2 d before) Incidence of PPB 2.1% Lozoya-González et al [99 ] 2012 Mexico Retrospective 24 PEG Thienopyridines (ceased 1-3 d before) No incidence of PPB Lee et al [123 ] 2013 South Korea Retrospective 81 PEG Thienopyridines (continued) No incidence of PPB
Table 33 Diagnostic endoscopy and colonoscopy with biopsy
Ref. Year Country Study design n Procedure Medication Relative risk Ono et al [104 ] 2012 Japan Prospective 101 Endoscopic biopsy DAPT (continued) No Incidence of PPB Ara et al [6 ] 2015 Japan Prospective 3758 Endoscopic biopsy DAPT either: (1) Continued; (2) Ceased before Incidence of PPB on DAPT (continued) 0.35%. No incidence of PPB with DAPT (cessation) Yuki et al [7 ] 2017 Japan Prospective 277 Endoscopic biopsy DAPT (continued) No incidence of PPB Kono et al [105 ] 2017 Japan Prospective 221 Endoscopic biopsy DAPT (continued) No incidence of PPB
Table 34 Endoscopic ultrasound ± fine needle aspiration
Ref. Year Country Study design n Procedure Medication Relative risk Kawakubo et al [106 ] 2018 Japan Prospective 85 EUS + FNA (for solid lesions only). Pancreatic cysts excluded DAPT (ceased thienopyridine 5 d before and bridged with aspirin monotherapy) Incidence of PPB 3.6%
Table 35 Polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Singh et al [28 ] 2010 United States Retrospective 77 Size: < 5 mm to ≥ 10 mm Polypectomy DAPT (continued) Incidence of delayed PPB 5.2% Feagins et al [30 ] 2011 United States Retrospective 118 Size: < 20 mm and > 20 mm Polypectomy DAPT (continued) Incidence of PPB 0.85% Kishida et al [41 ] 2019 Japan Retrospective 6382 Size: < 10 mm or ≥ 10 mm Polypectomy DAPT either: (1) Ceased 7 d before (before 2012); (2) Bridged with aspirin monotherapy (after 2012) Incidence of PPB 1.8% Watanabe et al [109 ] 2020 Japan Retrospective 50 Size: < 10 mm or ≥ 10 mm Polypectomy DAPT (various timing of agent continuation or switching strategies) Incidence of PPB 6%
Table 36 Cold snare polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Arimoto et al [111 ] 2019 Japan Retrospective 516 Size: ≤ 10 mm CSP DAPT (continued) No incidence of PPB Won et al [112 ] 2019 South Korea Prospective 91 Size: ≤ 10 mm CSP DAPT (continued) Incidence of PPB 2.4%
Table 37 Endoscopic mucosal resection
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Ono et al [113 ] 2019 Japan Retrospectively 825 Size: Median size ranged from 8.5-9.5 ± 5 mm EMR DAPT (thienopyridines ceased and aspirin monotherapy continued) Incidence of PPB per polyp resection 1.35% (aspirin/thienopyridine/DAPT) So et al [50 ] 2019 South Korea Retrospective 399 Size: Mean lesion size 34 mm EMR and ESD DAPT (varying patterns of agent continuation or switching strategies) Incidence of PPB 12.3%
Table 38 Endoscopic submucosal dissection
Ref. Year Country Study design n Procedure Medication Relative risk Sato et al [57 ] 2017 Japan Retrospective 75 (2378) ESD DAPT (ceased thienopyridine before and bridged with aspirin monotherapy) Incidence of PPB 30.7% Kono et al [58 ] 2018 Japan Retrospective 6 (872) ESD DAPT (ceased thienopyridine 7 d before and bridged with aspirin monotherapy) Incidence of PPB 67.7% Oh et al [116 ] 2018 South Korea Retrospective 51 (215) ESD DAPT either: (1) Ceased 5-7 d before (discontinuation group); (2) Ceased 0-4 d before (continuation group) Incidence of delayed PPB 27.5% (14/51) Harada et al [117 ] 2019 Japan Retrospective 59 (597) ESD DAPT either: (1) Ceased thienopyridine 5 d before and bridged with aspirin monotherapy (high-risk conditions); (2) DAPT ceased > 5 d before (low-risk conditions) Incidence of PPB 23.1% (aspirin monotherapy bridging). Incidence of PPB 5.0% (DAPT ceased)
Table 39 Endoscopic retrograde cholangiopancreatography with sphincterotomy
Ref. Year Country Study design n Procedure Medication Relative risk Mok et al [130 ] 2017 United States Prospective 50 Sphincterotomy DAPT (continued) Incidence of PPB 3.6% Yamamiya et al [122 ] 2019 Japan Retrospective 76 Sphincterotomy DAPT either: (1) Continued; (2) Ceased 5-7 d. And switched to aspirin monotherapy before No incidence of PPB in either continuous or cessation group
Table 40 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion
Ref. Year Country Study design n Procedure Medication Relative risk Lee et al [123 ] 2013 South Korea Retrospective 40 (1625) PEG DAPT (ceased 4 d before) Incidence of PPB on DAPT 2.5% Singh et al [98 ] 2012 United States Retrospective 122 (1541) PEG DAPT Incidence of PPB 2.5% Lozoya-González et al [99 ] 2012 Mexico Retrospective 91 PEG DAPT (ceased 1-3 d before) Incidence of PPB 0%
Table 41 Diagnostic endoscopy and colonoscopy with biopsy
Ref. Year Country Study design n Procedure Medication Relative risk Fujita et al [5 ] 2015 Japan Retrospective 47 Endoscopic biopsy Warfarin (continued) No incidence of PPB. Risk of immediate/intraprocedural bleeding 4.3% Ara et al [6 ] 2015 Japan Prospective 3758 Endoscopic biopsy Warfarin either: (1) Continued; (2) Ceased before No incidence of PPB on continuous or Warfarin cessation Ono et al [104 ] 2012 Japan Prospective 101 Endoscopic biopsy Warfarin (continued) No Incidence of PPB Yuki et al [7 ] 2017 Japan Prospective 277 Endoscopic biopsy Warfarin (continued) No incidence of PPB Kono et al [105 ] 2017 Japan Prospective 221 Endoscopic biopsy Warfarin (continued) No incidence of PPB when on warfarin monotherapy
Table 42 Endoscopic ultrasound ± fine needle aspiration
Ref. Year Country Study design n Procedure Medication Relative risk Inoue et al [17 ] 2017 Japan Retrospective 742 EUS + FNA Warfarin (ceased 4 d before) No incidence of bleeding in either discontinuation warfarin or HBT Kawakubo et al [106 ] 2018 Japan Prospective 85 EUS + FNA Warfarin (ceased 3 d with HBT before) Incidence of PPB with HBT 4%
Table 43 Polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Horiuchi et al [133 ] 2014 Japan Prospective 35 Size: ≤ 10 mm Polypectomy Warfarin (continued) Incidence of PPB 14% Beppu et al [134 ] 2014 Japan Retrospective 20 Size: ≥ 20 mm and < 20 mm Polypectomy Warfarin ± HBT (ceased at least 5 d before) Incidence of PPB 52.2% Yanagisawa et al [1 ] 2018 Japan Retrospective 486 Size: < 10 mm or ≥ 10 mm Polypectomy Warfarin ± HBT (ceased 3-5 d before) Incidence of PPB 13.7%. Incidence of PPB on HBT 21.7% Lin et al [107 ] 2018 United States Retrospective 427 Size: < 20 or ≥ 20 mm Polypectomy Warfarin ± HBT (ceased 3-5 d before) Incidence of PPB 0.66% Yu et al [127 ] 2019 United States Retrospective 3471 N/S Polypectomy Warfarin ± HBT (ceased before procedure) Incidence of PPB 1.2% Kishida et al [41 ] 2019 Japan Retrospective 6382 Size: < 10 mm or ≥ 10 mm Polypectomy Warfarin ± HBT (ceased 3-4 d before) Incidence of PPB 2.3%. Incidence of PPB with HBT 20% (study did not discern rates between warfarin vs DOAC) Amato et al [108 ] 2019 Italy Prospective n=1504 Size: ≥ 10 mm Polypectomy Warfarin(ceased median 5 d before) Incidence of PPB 8.5% (anticoagulant monotherapy)(study did not discern rates between warfarin vs DOAC)
Table 44 Cold snare polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Horiuchi et al [133 ] 2014 Japan Prospective 35 Size: ≤ 10 mm CSP Warfarin (continued) No incidences of PPB Makino et al [110 ] 2018 Japan Prospective 69 Size: ≤ 10 mm CSP Warfarin (continued) No incidences of PPB. Incidence of immediate/intraprocedural bleeding 5.7% Arimoto et al [111 ] 2019 Japan Retrospective 501 Size: ≤ 10 mm CSP Warfarin (continued) No incidences of PPB. Incidence of immediate/intraprocedural bleeding 9.8%
Table 45 Endoscopic mucosal resection
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Fujita et al [135 ] 2018 Japan Prospective (non-HBT group). Retrospective (HBT group) 43/41 Size: < 10 mm (mean size 7.2-7.8 mm ± 2.2-3.2 mm) EMR Warfarin ± HBT (ceased morning of) No incidence of PPB (non-HBT group). Incidence of PPB 9.8% (HBT group) Ono et al [113 ] 2019 Japan Retrospective 24 Size: Median size ranged from 8.5-9.5 ± 5 mm between groups EMR Warfarin ± HBT either: Continued; ceased 3 d before procedure Incidence of PPB (without HBT) 10%. Incidence of PPB (with HBT) 21.4% So et al [50 ] 2019 South Korea Retrospective 1197 Size: Mean lesion size 34 mm EMR Warfarin either: Ceased day of; 0-4 d before; ceased 5-7 d before; ceased 8-14 d before Incidence of PPB 16.7% (specific PPB rates between warfarin and DOACs N/S). Incidence of PPB (HBT group) 35.7% Albéniz et al [114 ] 2020 Spain Prospective 76 Size: ≥ 20 mm (mean size 30.5 mm) EMR Warfarin (ceased 5 d before with HBT) Increased risk of PPB with anticoagulant use (OR: 4.54, 95%CI: 2.14-9.63, P < 0.001). Incidence of PPB not specified in study
Table 46 Endoscopic submucosal dissection
Ref. Year Country Study design n Procedure Medication Relative risk Igarashi et al [56 ] 2017 Japan Retrospective 67 ESD Warfarin ± HBT either: (1) Received till day of; (2) Ceased 3-7 d before; (3) HBT 3-7 d before Incidence of PPB 10.0% (warfarin and DOAC combined). Incidence of PPB 10.8% (HBT group) Sato et al [57 ] 2017 Japan Retrospective 93 ESD Warfarin ± HBT (ceased 3-5 d before) Incidence of PPB 5.9% (without HBT). Incidence of PPB (with HBT) 30.7% Furuhata et al [115 ] 2017 Japan Retrospective 253 ESD Warfarin ± HBT (ceased 3-4 d before) Incidence of PPB 7.3% (Warfarin and DOAC combined). Incidence of PPB 28.8% (with HBT) Yoshio et al [132 ] 2017 Japan Retrospective 97 ESD Warfarin ± HBT (ceased 4-5 d before) No incidence of PPB (without HBT). Incidence of PPB (with HBT) 31.6% Harada et al [136 ] 2017 Japan Prospective 45 ESD Warfarin ± HBT either: (1) Continued; (2) Switched to HBT Incidence of PPB 9.1% (warfarin continued). Incidence of PPB 21.7% (HBT) Kono et al [58 ] 2018 Japan Retrospective 872 ESD Warfarin ± HBT (ceased 1-3 d before with or without HBT) Incidence of PPB 6.4% (without HBT). Incidence of PPB 29% (with HBT) (warfarin and DOACs combined) Yamashita et al [60 ] 2018 Japan Retrospective 650 ESD Warfarin with HBT Incidence of PPB 26.3% (with HBT) Nam et al [118 ] 2019 South Korea Retrospective 1942 ESD Warfarin ± HBT (ceased 7 d before) Incidence of PPB 3.2% Harada et al [61 ] 2020 Japan Retrospective 26 ESD Warfarin ± HBT either: (1) Continued; (2) Ceased 4-5 d ± HBT before Incidence of PPB 7.7%
Table 47 Endoscopic retrograde cholangiopancreatography with sphincterotomy
Ref. Year Country Study design n Procedure Medication Relative risk Paik et al [137 ] 2018 South Korea Retrospective 96 Sphincterotomy Warfarin with HBT Incidence of delayed PPB 7.3% Muro et al [138 ] 2020 Japan Retrospective 149 Sphincterotomy Warfarin either: (1) Continued; (2) With HBT Incidence of PPB 8.3% (warfarin continued). Incidence of PPB 4.0% (with HBT) Yamamiya et al [122 ] 2019 Japan Retrospective 76 Sphincterotomy Warfarin: (1) Continued; (2) With HBT No incidence of PPB in either continuous or HBT group Ikarashi et al [68 ] 2017 Japan Retrospective 1113 Sphincterotomy Warfarin either: (1) Ceased 4-5 d before; (2) With HBT Incidence of delayed PPB 3.0% (study categorised cessation of thienopyridine, warfarin and DOAC into the same “discontinuation” group). Incidence of PPB 8.0% (with HBT)
Table 48 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion
Ref. Year Country Study design n Procedure Medication Relative risk Lee et al [123 ] 2013 South Korea Retrospective 71 PEG Warfarin (continuation or cessation details N/S) Study findings expressed as an OR. Increased risk of PPB with anticoagulant use (OR: 7.26, 95%CI: 2.23-23.68, P = 0.001) Singh et al [98 ] 2012 United States Retrospective 326 PEG Warfarin ± HBT Without HBT group: (1) Incidence of PPB 5.4% (without HBT); (2) Increased risk of PPB without HBT (OR: 1.08, 95%CI: 0.47-2.49, P = 0.860). HBT group: (1) Incidence of PPB with HBT 7.9% (11/140); (2) Increased risk of PPB with HBT (OR: 2.66, 95%CI: 1.18-5.99, P = 0.018) Lozoya-González et al [99 ] 2012 Mexico Retrospective 91 PEG Warfarin either: (1) Ceased > 48h with HBT before; (2) Ceased 1-5 d before No incidence of PPB
Table 49 Diagnostic endoscopy and colonoscopy with biopsy
Ref. Year Country Study design n Procedure Medication Relative risk Fujita et al [5 ] 2015 Japan Retrospective 5 (7939) Endoscopic biopsy DOAC (continued) No incidence of PPB Ara et al [6 ] 2015 Japan Prospective 394 (3758) Endoscopic biopsy DOAC either: (1) Continued; (2) Ceased before No incidence of PPB(in both continuous and DOAC cessation group) Yuki et al [7 ] 2017 Japan Prospective 45 (549) Endoscopic biopsy DOAC (continued) No incidence of PPB Kono et al [105 ] 2017 Japan Prospective 51 (221) Endoscopic biopsy DOAC (continued) No incidence of PPB
Table 50 Endoscopic ultrasound ± fine needle aspiration
Ref. Year Country Study design n Procedure Medication Relative risk Kawakubo et al [106 ] 2018 Japan Prospective 85 EUS + FNA DOAC (ceased 48 h with HBT before) No incidence of PPB with HBT
Table 51 Polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Beppu et al [134 ] 2014 Japan Retrospective 1 (52) Size: ≥ 20 mm and < 20 mm Polypectomy DOAC (ceased at least 5 d before) Expressed as OR. Increased risk of PPB with DOAC use (OR: 10.2, 95%CI: 2.7-38.3, P = 0.0006) Yanagisaw et al [1 ] 2018 Japan Retrospective 73 (436) Size: < 10 mm or ≥ 10 mm Polypectomy DOAC (ceased 24-48 h before ± HBT) Incidence of PPB 13.8% Yu et al [127 ] 2019 United States Retrospective 1590 (611487) N/S Polypectomy DOAC (ceased before) Incidence of PPB 0.6% Kishida et al [41 ] 2019 Japan Retrospective 87 (6382) Size: < 10 mm or ≥ 10 mm Polypectomy DOAC (ceased 24-48 h before) Incidence of PPB 2.3% (study did not discern rates between warfarin vs DOAC) Amato et al [108 ] 2019 Italy Prospective 1504 Size: ≥ 10 mm Polypectomy DOAC (ceased median 5 d before) Incidence of PPB 8.5% (study did not discern anticoagulant rates between warfarin vs DOACs)
Table 52 Cold snare polypectomy
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Makino et al [110 ] 2018 Japan Prospective 17 (172) Size: ≤ 10 mm CSP DOAC (continued) Incidence of PPB 1.2% Arimoto et al [111 ] 2019 Japan Retrospective 65 (501) Size: ≤ 10 mm CSP DOAC (continued) No incidence of PPB
Table 53 Endoscopic mucosal resection
Ref. Year Country Study design n Polyp morphology Procedure Medication Relative risk Fujita et al [135 ] 2018 Japan Prospective (non-HBT group) and retrospective (HBT group) 84 Size < 10mm (mean size 7.2-7.8 ± 2.2-3.2 mm EMR DOAC ± HBT (ceased morning of) Incidence of PBB 2.3% (non-HBT). No incidence of PPB (HBT) Ono et al [113 ] 2019 Japan Retrospective 825 Size median size 8.5-9.5 ± 5 mm between groups EMR DOACs (ceased day of) Incidence of PPB 6.5% So et al [50 ] 2019 South Korea Retrospective 399 (1197) Size mean lesion 34 mm EMR and ESD DOAC (ceased day of procedure or 0-4 d before or ceased 5-7 d before or ceased 8-14 d before procedure) Incidence of PPB 16.7% (anticoagulant group) (study did not specify the risk comparing warfarin and DOAC individually) Albénizet al [114 ] 2020 Spain Prospective 977 Size ≥ 20mm (mean size 30.5 mm) EMR DOAC (ceased 48-72 h before) Expressed as OR (OR: 4.54, 95%CI: 2.14-9.63, P < 0.001) (anticoagulant use) (specific PPB rates between warfarin and DOACs not specified)
Table 54 Endoscopic submucosal dissection
Ref. Year Country Study design n Procedure Medication Relative risk Igarashi et al [56 ] 2017 Japan Retrospective 30 ESD DOAC (ceased 3-7 d before) Incidence of PPB 10.0% (warfarin and DOAC combined) Sato et al [57 ] 2017 Japan Retrospective 18 ESD DOAC (ceased 24-48 h before) Incidence of PPB 5.6% Yoshio et al [132 ] 2017 Japan Retrospective 24 ESD DOAC: (1) Rivaroxaban/Apixaban ceased 2 d before; (2) Dabigatran ceased 1-2 d before Incidence of PPB on Rivaroxaban 45.5%. No incidence of PPB on dabigatran or apixaban Kono et al [58 ] 2018 Japan Retrospective 872 ESD DOAC either: (1) Ceased 1-3 d before; (2) Ceased 2 d before with HBT DOACs ceased 1-3 d before without HBT group: (1) Incidence of PPB 6.4%; (2) Warfarin and DOACs with HBT: Incidence of PPB 29% Yamashita et al [60 ] 2018 Japan Retrospective 650 ESD DOAC (ceased morning of) Incidence of PPB 22.2% Harada et al [61 ] 2020 Japan Retrospective 25 ESD DOAC (ceased 1 d before ± HBT) Incidence of PPB 16%
Table 55 Endoscopic retrograde cholangiopancreatography with sphincterotomy
Ref. Year Country Study design n Procedure Medication Relative risk Yamamiya et al [122 ] 2019 Japan Retrospective 76 Sphincterotomy DOAC either: (1) Continued; (2) Switched to HBT before No incidence of PPB in either continuous or HBT group Muro et al [138 ] 2020 Japan Retrospective 62 (149) Sphincterotomy DOAC: (1) Continued; (2) With HBT No incidence of PPB (continued DOAC). Incidence of PPB 6.5% (HBT)
Table 56 Percutaneous endoscopic gastrostomy/percutaneous endoscopic jejunostomy insertion
Ref. Year Country Study design n Procedure Medication Relative risk Lee et al [123 ] 2013 South Korea Retrospective 71 (1625) PEG DOAC (N/S whether continued or ceased before) Study expressed risk of PPB as OR (OR: 7.26, 95%CI: 2.23-23.68, P = 0.001) (included both warfarin and DOAC)