Continued Aspirin Treatment May Be a Risk Factor of Delayed Bleeding after Gastric Endoscopic Submucosal Dissection under Heparin Replacement: A Retrospective Multicenter Study

Abstract

Objective Gastric endoscopic submucosal dissection (ESD) under heparin replacement (HR) of warfarin reportedly has a high risk of delayed bleeding (24-57%). It is possible that the delayed bleeding risk may have changed over the years. We evaluated the current risk of delayed bleeding after gastric ESD under HR of anticoagulant agents. Methods We retrospectively reviewed the delayed bleeding rate and analyzed the risk factors for delayed bleeding. Patients Consecutive patients who underwent gastric ESD under HR of anticoagulant agents from July 2015 to June 2017. Results A total of 32 patients with a solitary early gastric cancer and taking anticoagulant agents were analyzed, including 24 patients on warfarin (the warfarin group) and 8 patients on direct oral anticoagulants (the DOAC group). Three (9.4%) patients experienced delayed bleeding: three (12.5%) patients in the warfarin group and no patients in the DOAC group. Continued aspirin treatment was identified to be a risk factor of delayed bleeding (p=0.01). Conclusion Careful management may be required for patients undergoing gastric ESD under continued aspirin treatment in addition to HR of anticoagulant agents; although the delayed bleeding risk after gastric ESD under HR of anticoagulant agents might have decreased over the years.

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

“…Detailed information about the excluded studies is presented in the supporting information. Eventually, 30 articles were included 24–53 …”

“…Others were conducted in Japan. Ten studies focused on PPB of DOACs and warfarin in ESD 24,25,27,29,37,40,41,43,46,50 . Only two studies mentioned the usage of epinephrine as injection solution 50,53 .…”

Management of anticoagulants in delayed bleeding after endoscopic resection: A systematic review and meta-analysis

“…After reviewing the full-text of the remaining 27 articles, a total of 19 studies were found to be ineligible for the inclusion criteria, and were excluded. Finally, eight studies 11 12 13 14 15 16 17 18 were included for the meta-analysis. Results of the study flow diagram are shown in Fig.…”

“…A total of five articles 11 12 13 17 18 were included in the network. Based on the management of anticoagulants, six different groups assigned.…”

“…All articles demonstrated the outcome, and five of these [11][12][13][14][15] reported no thrombotic events. Therefore, the meta-analysis was conducted using three studies [16][17][18] with a total of 1,085 patients (601 patients with warfarin and 484 patients with DOACs).…”