Electronic Supplementary Material 1High-risk thromboembolic events associated with withdrawal of antithrombotic therapy

High-risk conditions associated with withdrawal of anticoagulants / History of cardiogenic cerebral embolism
Atrial fibrillation associated with valvular heart disease
Mechanical valve in the mitral position
Mechanical valve and prior thromboembolic event
Prosthetic valve in any position
Anti-phospholipid antibody syndrome
High-risk conditions associated with withdrawal of antiplatelet agents / 2 months following coronary artery bare metal stenting
12 months following coronary artery drug-eluting stenting (DES)
2 months following carotid endarterectomy/carotid artery stenting
Prior stroke or transient ischemic attack with > 50% stenosis of major intracranial arteries
Recent ischemic stroke or transient ischemic attack
Obstructive peripheral artery disease  Fontaine grade 3
Ultrasonic examination of carotid arteries and magnetic resonance angiography of head and neck region where withdrawal is considered high risk of thromboembolism

Electronic Supplementary Material2 Risk for bleeding with endoscopic procedures

Low-risk / Upper and lower gastrointestinal endoscopy including biopsy
Capsule endoscopy
Enteroscopy and balloon-assisted enteroscopy including biopsy
Marking (clipping, electrocoagulation, tattooing, APC)
Endoscopic gastroenterological dilation procedures
Gastrointestinal, pancreatic duct, biliary duct stenting without incision
ERCP without sphincterotomy, EPBD
EUS without FNA
High-risk / Polypectomy
EMR/ESD
Endoscopic duodenal sphincterotomy (papillectomy)
Endoscopic papillectomy
EUS-FNA
PEG placement
Treatment of varices
Others

APC, argon plasma coagulation; ERCP, endoscopic retrograde cholangiopancreatography; EPBD, endoscopic papillary balloon dilatation; EUS, endoscopic ultrasound-guided sampling; FNA, fine-needle aspiration; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; PEG, percutaneous endoscopic gastrostomy

Electronic Supplementary Material3Thrombotic/bleeding risk associated with pre-procedural cessation/post-procedural resumption of antithrombotic agents

Thrombotic risk / Pre-procedural cessation / Post-procedural resumption
Bleeding risk
Low / High / Low / High
Antiplatelet agents / Aspirin / Low / 3 days/
On the day of procedure / 3 days / On the day after procedure / Within 2 days
High / On the day of procedure / Continued use/
bridging with cilostazol
Clopidogrel
Ticlopidine / Low / 5 days/
On the day of procedure / 5 days
High / On the day of procedure / 5 days + bridging with aspirin or cilostazol
Cilostazol or any other antiplatelet agent / All / On the day of procedure
Anticoagulants / Novel oral anticoagulants (NOACs) / Low / On the day of procedure / 24 hours/
2 days for the elderly/renal failure
High / 2 days + bridging with heparin
Warfarin / Low / Continued at INR < 2.6 / Continued at INR < 2.6 on the day of procedure/
3 days / On the day after procedure
High / 3 days + bridging with heparin / Within 24 hours
Warfarin and heparin

Electronic Supplementary Material4 Baseline characteristics of the 4,921 patients who adhered with the Sapporo consensus

Median age (range) / 73 (20-98)
n / %
Gender (male/female) / 3,162/1,759 / 64.3/35.7
Comorbidity
Cerebral infarction / 1,574 / 32.0
Ischemic heart disease / 1,369 / 27.8
Atrial fibrillation / 709 / 14.4
Deep-vein thrombosis / 74 / 1.5
Arteriosclerosis obliterans / 219 / 4.5
Anti-phospholipid antibody syndrome / 7 / 0.1
Valvular heart disease / 72 / 1.5
Renal failure/dialysis / 67 / 1.4
Antithrombotic agents
Aspirin / 2,553 / 51.9
Thienopyridines / 1,062 / 21.5
Cilostazol / 433 / 8.8
warfarin / 979 / 19.9
Novel oral anticoagulants (NOACs) / 986 / 20.0

Electronic Supplementary Material5Complications/sequels associated with procedures in patients who adhered with the Sapporo consensus

n (%)
Overall / Bleeding / Thrombosis
44/6,531 (0.67) / 1/6,531 (0.02)
Bleeding / Patients on ATA / Control / Odds ratio (95% CI) / P value
n (%)
Diagnostic EGD / 0/2,678 (0) / 1/20,230 (0.005) / 2.519 (0.103-61.89) / 0.233
Diagnostic colonoscopy / 0/1,250 (0) / 1/8,726 (0.012) / 2.326 (0.095-57.17) / 0.258
Gastric/esophageal
EMR, ESD / 5/125 (4) / 26/315 (8.25) / 0.463 (0.174-1.235) / 0.148
Colonic EMR, ESD / 34/704 (4.83) / 34/2,115 (1.61) / 3.106 (1.915-5.037) / < 0.001

ATA, antithrombotic agents; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection

Electronic Supplementary Material 6Univariate analysis of bleeding complications associated with procedures/antithrombotic agents in patients who adhered with the Sapporo consensus

Associated bleeding complications / Fisher’s exact test
n (%)
Antithrombotic agents
Use of anticoagulants / 13/1,295 (1.00) / P = 0.127
No / 31/5,236 (0.59)
Use of LDA / 20/3,090 (0.65) / P = 0.880
No / 24/3,441 (0.70)
Use of thienopyridine antiplatelet / 18/1,359 (1.32) / P = 0.002
No / 26/5,172 (0.50)
Monotherapy / 31/5,651 (0.55) / P =0.006
Combination therapy / 13/880 (1.48)
Bridging therapy
None / 4/394 (1.02) / P 0.0001
Cilostazol / 3/51 (5.88)
Heparin / 7/62 (11.29)
Procedure risk for bleeding
Low / 12/5,735 (0.21) / P 0.0001
High / 32/784 (4.08)
Thromboembolic Risk
Low / 30/6,025 (0.50) / P 0.0001
High / 14/506 (2.77)

LDA, Low-dose aspirin

Electronic Supplementary Material7 Univariate analysis of bleeding complications associated with clinical factors in patients who adhered tothe Sapporo consensus criteria

Clinical factor / Associated bleeding complications / Fisher’s exact test
n (%)
Gender
Male / 31/3,162 (0.98) / P = 0.063
Female / 8/1,759 (0.45)
Age
< 65 years old / 8/897 (0.89) / P = 0.678
> 65 years old / 31/4,024 (0.77)
Cerebral infarction
Yes / 12/1,574 (0.76) / P = 1.000
No / 27/3,347 (0.81)
Ischemic heart disease
Yes / 15/1,369 (1.10) / P = 0.151
No / 24/3,552 (0.68)
Atrial fibrillation
Yes / 7/709 (0.99) / P = 0.493
No / 32/4,212 (0.76
Deep-vein thrombosis
Yes / 0/74 (0.0) / P = 1.000
No / 39/4,847 (0.8)
Arteriosclerosis obliterans
Yes / 1/219(0.46) / P = 1.000
No / 38/4,702 (0.81)
Renal failure/dialysis
Yes / 4/67 (5.97) / P = 0.018
No / 35/4,854 (0.72)
Anti-phospholipid antibody syndrome
Yes / 0/7(0.0) / P = 1.000
No / 39/4,914 (0.79)
Valvular heart disease
Yes / 3/72 (4.17) / P = 0.019
No / 36/4,849 (0.74)
Thromboembolic risk
Low / 27/4,517 (0.60) / P < 0.001
High / 12/404 (2.97)
Procedure risk for bleeding
Low / 12/4,283 (0.28) / P < 0.001
High / 27/638 (4.23)

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