scholarly journals Use of direct oral anticoagulants does not significantly increase delayed bleeding after endoscopic submucosal dissection for early gastric neoplasms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jinju Choi ◽  
Soo-Jeong Cho ◽  
Sang-Hoon Na ◽  
Ayoung Lee ◽  
Jue Lie Kim ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Target Lesion ◽  
University Hospital ◽  
Gastric Neoplasms ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Hospital Patients ◽  
National University

AbstractDirect oral anticoagulants (DOACs) are widely prescribed for the prevention of stroke in elderly patients with atrial fibrillation and approved indication for DOAC has been expanded. We aimed to evaluate the risk of delayed bleeding in patients who had taken DOAC and underwent endoscopic submucosal dissection (ESD) for gastric neoplasms. We included consecutive patients who underwent ESD between January 2016 and July 2019 in Seoul National University Hospital. Patients were divided into four groups (no med; no medication, DOAC, WFR; warfarin, anti-PLT; anti-platelet agent) according to the medications they had been taken before the procedure. We defined delayed bleeding as obvious post-procedural gastrointestinal bleeding sign including hematemesis or melena combined with hemoglobin drop ≥ 2 g/dL. Among 1634 patients enrolled in this study, 23 (1.4%) patients had taken DOAC and they usually stopped the medication for 2 days before the ESD and resumed within 1 or 2 days. We compared rates of delayed bleeding between groups. Delayed bleeding rates of the groups of no med, DOAC, WFR, and anti-PLT were 2.1% (32/1499) 8.7% (2/23), 14.3% (2/14), 11.2% (11/98), respectively (P < 0.001). However, there was no difference of delayed bleeding rate between no med and DOAC group after propensity score matching (no med vs DOAC, 1.7% vs 10.0%, P = 0.160). Taking DOAC was not associated statistically with post-ESD bleeding when adjusted by age, sex, comorbidities and characteristics of target lesion (Adjusted Odds Ratio: 2.4, 95% Confidence intervals: 0.41–13.73, P = 0.335). Crude rate of bleeding in DOAC users seemed to be higher than no medication group after performing ESD with 2 days of medication cessation. When adjusted by age, sex, and comorbidity, however, this difference seems to be small, which suggests that gastric post-ESD bleeding may be influenced by patients’ underlying condition in addition to medication use.

scholarly journals Use of anticoagulants increases risk of bleeding after colorectal endoscopic submucosal dissection

2018 ◽  
Vol 06 (07) ◽  
pp. E857-E864 ◽  
Author(s):  
Ken Yamashita ◽  
Shiro Oka ◽  
Shinji Tanaka ◽  
Kazuki Boda ◽  
Daiki Hirano ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Perioperative Period ◽  
University Hospital ◽  
En Bloc ◽  
Risk Of Bleeding ◽  
Warfarin Group ◽  
Submucosal Dissection ◽  
Clinical Records

Abstract Background and study aims Japanese guidelines for gastroenterological endoscopy have recommended temporary withdrawal of anticoagulants (warfarin, direct oral anticoagulants [DOAC], or heparin) to prevent hemorrhagic complications during endoscopic submucosal dissection (ESD) for colorectal neoplasias (CRNs). However, serious thrombosis might occur during temporary withdrawal of anticoagulants. The current study aimed to evaluate outcomes with anticoagulants in patients undergoing ESD for CRNs. Patients and methods This study was a single-institution retrospective cohort study based on clinical records. We assessed 650 consecutive patients with 698 CRNs who underwent ESD at Hiroshima University Hospital between December 2010 and June 2016. The patients were divided into three groups: the warfarin group (19 patients with 19 CRNs), DOAC group (7 patients with 9 CRNs), and no-antithrombotics group (624 patients with 670 CRNs). We replaced warfarin with heparin 3 to 5 days before endoscopy. Although DOAC was suspended on the morning of endoscopy, we did not replace heparin. Results Bleeding after the procedure occurred in 26.3 % (5/19), 22.0 % (2/9), and 2.7 % (18/670) of patients in the warfarin, DOAC, and no-antithrombotics groups, respectively. In the warfarin group, four patients who bled after the procedure took not only warfarin but also other antiplatelets. En bloc resection rates were 94.7 % (18/19), 100 % (9/9), and 96.6 % (647/670) in the warfarin, DOAC, and no-antithrombotics groups, respectively. No patients experienced ischemic events in the perioperative period. Conclusions Among patients undergoing ESD for CRNs, risk of bleeding was higher among patients who took anticoagulants than among those who did not. In particular, careful attention to patients who took antiplatelets in addition to warfarin before ESD for CRNs is warranted.

Effect of direct oral anticoagulants on the risk of delayed bleeding after gastric endoscopic submucosal dissection

2017 ◽  
Vol 29 (6) ◽  
pp. 686-694 ◽  
Author(s):  
Toshiyuki Yoshio ◽  
Hideomi Tomida ◽  
Ryuichiro Iwasaki ◽  
Yusuke Horiuchi ◽  
Masami Omae ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Delayed Bleeding ◽  
Submucosal Dissection

Risk factors for delayed bleeding from endoscopic submucosal dissection of gastric neoplasms

2012 ◽  
Vol 47 (8-9) ◽  
pp. 1108-1114 ◽  
Author(s):  
Munetaka Nakamura ◽  
Jun Nishikawa ◽  
Kouichi Hamabe ◽  
Junichi Nishimura ◽  
Masaaki Satake ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Submucosal Dissection ◽  
Gastric Neoplasms ◽  
Delayed Bleeding ◽  
Submucosal Dissection

scholarly journals Feasibility of Autologous Fibrin Glue and Polyglycolic Acid Sheets to Prevent Delayed Bleeding after Endoscopic Submucosal Dissection of Gastric Neoplasms in Patients Receiving Antithrombotic Therapy

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Daisuke Kikuchi ◽  
Toshiro Iizuka ◽  
Kosuke Nomura ◽  
Yasutaka Kuribayashi ◽  
Masami Tanaka ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Fibrin Glue ◽  
Antithrombotic Therapy ◽  
Polyglycolic Acid ◽  
Safety Measure ◽  
Gastric Neoplasms ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Autologous Fibrin Glue

Background/Aims. Delayed bleeding is one of the most serious complications following gastric endoscopic submucosal dissection (ESD) under antithrombotic therapy. As a safety measure, for patients receiving antithrombotic therapy, we covered the ESD ulcer with autologous fibrin glue (prepared using autologous blood) alone or with polyglycolic acid (PGA) sheets. Methods. From July 2014 to November 2015, 20 patients with gastric neoplasms who were receiving antithrombotic therapy were enrolled in this study. After ESD, the ESD ulcers were covered with autologous fibrin glue alone or with PGA sheets. We prospectively evaluated the feasibility of this safety measure. Results. In total, 22 lesions in 20 patients were resected en bloc by ESD. The mean specimen size and tumor size were 31.5 ± 9.5 mm and 14.0 ± 8.8 mm, respectively. There were no cases of delayed bleeding or adverse events in this study. Attachment of autologous fibrin glue was observed in 81.8% (18/22) and 68.2% (15/22) of lesions at endoscopy performed 1 day and 7 days after ESD, respectively. Conclusion. No patient in this study had delayed bleeding or adverse events. This suggests that this measure may facilitate the safety of gastric ESD in patients receiving antithrombotic therapy. This trial is registered with UMIN000019386.

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