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Argon plasma coagulation (APC) is an ablative therapy used for a wide variety of indications throughout the gastrointestinal tract. There are no data on continued use of antithrombotics with respect to the risk of bleeding after APC. Therefore, current ESGE guideline does not provide any guidance in this regard. This study aimed to assess post procedure bleeding risk and to identify its risk factors.

Methods: Multicentre retrospective cohort study including consecutive patients submitted to APC between November/2019 and February/2021. Antithrombotic therapy was managed as a high-risk procedure. Clinically significant post-procedure bleeding: haemoglobin value fall >2g/dL, blood transfusion or unplanned hospital admission.Results: Included 142 procedures in 120 patients [male:67 (67.8%); median age: 76 (68-80) years]. The main indications for APC were gastric angiodysplasias (45%) and radiation proctopathy (37%) and median power used was 35 (30-40) watts. A total of 34% of patients were under antithrombotic therapy (antiplatelet agents- 16%; anticoagulants- 18%). Post-APC bleeding was reported in 5 procedures (3.5%). Bleeding was clinically significant in 3 of the 5 cases and was successfully treated in all events with clips with or without adrenaline. In multivariate analysis, risk factors for post-APC bleeding were anticoagulant therapy (OR: 3.5; 95% CI: 1.1-30) and power <20 watts (OR: 12; 95% CI: 1.1-99). Antiplatelet agents use was not associated with post-APC bleeding (P=0.172).Conclusion: Post-APC bleeding was reported in 3.5% of cases, being higher for patients under anticoagulant therapy and lower APC power. Our results favour APC classification as a high procedure risk for bleeding.

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