LOW MOLECULAR WEIGHT HEPARIN TREATMENT DOES NOT INCREASE THE RISK OF BLEEDING AFTER PROPHYLACTIC ENDOSCOPIC VARICEAL BAND LIGATION IN PATIENTS WITH CIRRHOSIS

Introduction. Anticoagulants are commonly indicated in cirrhotics due to their high rate of thrombotic events. It’s not known if anticoagulants are safe in cirrhotics undergoing elective Endoscopic Variceal band Ligation (EVL). Aim. to define the short-term risk of bleeding after prophylactic EVL in cirrhotics treated with LMWH. Materials and Methods. All primary and secondary prophylactic EBL performed from January 2009 to September 2015 were restrospectively analyzed. Inclusion criteria: diagnosis of cirrhosis, age 18-85, EVL procedures started and completed at the same Institution during the observation period. Exclusion criteria: active bleeding at first endoscopy. Patients treated with LMWH were classified as Cases, the remaining as Controls. Clinical characteristics including ascites, hepatic encephalopathy and MELD, endoscopic features at the beginning and at the end of EVL treatment, number of EVL sessions, mean number of bands per session were recorded. EVL related bleeding was defined as endoscopic evidence of hemorrhage within 30 days from the procedure. Results. Among 26742 upper endoscopies, 542 were prophylactic EVLs performed in 245 (200 primary and 45 secondary prophylaxis) cirrhotics. 197 EVL sessions were performed in 76 Cases (4.81±0.92 bands/session) and 345 in 169 Controls (4.80±1.03; p=ns). 48 Cases (63%) were treated with 100 U/Kg/bid while the remaining with 70 U/Kg/bid. Clinical and endoscopic features were similar between the groups at the time of the first EVL and at the last treatment. Overall 5 patients bled (2%), 3 Cases (3.9%) and 2 Controls (1.2%, Log-Rank test 0.161). F2 and F3 varices with red marks (100% vs 54,7%, p 0.044) and the number of bands used at index EVL (5.8±0.4 vs 4.6±1.1, p=0.003) were different between bleeders and non-bleeders, respectively. Conclusions. Anticoagulation with LMWH does not increase the risk of post-procedural bleeding in cirrhotic patients undergoing prophylactic EBL.