Sa1035 Periendoscopic Management of Direct Oral Anticoagulants: A Prospective Cohort Study

Radaelli, Franco; Fuccio, Lorenzo; Paggi, Silvia; Leo, Milena Di; Trovato, Cristina; Tarantino, Ottaviano; Buda, Andrea; Musso, Alessandro; Bellis, Mario De; Fasoli, R.; Liverani, Elisa; Giardini, Maxemiliano; Giulio, Emilio Di; Hassan, Cesare; Repici, Alessandro; Dentali, Francesco

doi:10.1016/j.gie.2017.03.354

Cited by 14 publications

(26 citation statements)

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“…Regarding the latter, the use of antithrombotic therapy was independently associated with the risk of delayed but not intra-procedural bleeding. This risk was substantial, albeit comparable to that reported in other studies, [26][27][28] despite the fact that most patients were managed according to guidelines recommended for peri-endoscopic management of antithrombotics. 29 This indirectly supports the conclusions of a costeffectiveness study showing that, for polyps >10 mm in size, prophylactic endoscopic clipping was cost-effective for patients receiving APAS or anticoagulant agents.…”

Section: Discussionsupporting

confidence: 82%

Intra‐procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study

et al. 2019

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Background and aim The safety of endoscopic resection of large colorectal lesions (LCLs) (≥20 mm) is clinically relevant. The aim of the present study was to assess the rate of post-resection adverse events (AEs) in a real-life setting. Patients and methods In a prospective, multicentre, observational study, data from consecutive resections of LCLs over a 6-month period were collected in 24 centres. Patients were followed up at 15 days from resection for AEs. The primary endpoint was intra-procedural bleeding according to lesion morphology. Secondary endpoints were delayed bleeding and perforation. Patient and polyp characteristics, and polypectomy techniques were analysed with respect to the bleeding events. Results In total, 1504 patients (female/male: 633/871, mean age, 66.1) with 1648 LCLs (29.1% pedunculated and 70.9% non-pedunculated lesions) were included. Overall, 168 (11.2%) patients had post-resection bleeding (8.5 and 2.0% immediate and delayed, respectively), while 15 (1.0%) cases of perforation occurred. Independent predictors of immediate bleeding for pedunculated lesions were bleeding prophylaxis (odds ratio (OR) 0.28, 95% confidence interval (CI) 0.13–0.62), simple polypectomy (versus endoscopic mucosal resection, OR 0.38, 95% CI 0.17–0.88) and inpatient setting (OR 2.21, 95% CI 1.07–5.08), while bleeding prophylaxis (OR 0.37, 95% CI 0.30–0.98), academic setting (OR 0.27, 95% CI 0.12–0.54) and size (OR 1.03, 95% CI 1.00–1.05) were predictors for those non-pedunculated. Indication for colonoscopy (screening versus diagnostic (OR 0.33, 95% CI 0.12–0.86)), antithrombotic therapy (OR 3.12, 95% CI 1.54–6.39) and size (OR 2.34, 95% CI 1.12–4.87) independently predicted delayed bleeding. Conclusions A low rate of post-resection AEs was observed in a real-life setting, reassuring as to the safety of endoscopic resection of ≥2 cm colorectal lesions. Bleeding prophylaxis reduced the intra-procedural bleeding risk, while antithrombotic therapy increased delayed bleeding. CLINICALTRIAL: (NCT02694120).

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Section: Discussionsupporting

confidence: 82%

Intra‐procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study

et al. 2019

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“…In this study, delayed bleeding in the DOAC group with long-term discontinuation that did not follow the guidelines occurred in two of six patients. Radaelli et al reported that delayed resumption did not result in a decreased bleeding risk in gastrointestinal endoscopy [33], which was consistent with the results of the present ▶ Fig. 1 Rates of delayed bleeding according to the management strategies and DOAC types.…”

Section: E1658supporting

confidence: 92%

“…In this study, none of the patients had thromboembolism. Several reports have shown that the rate of thromboembolic events in the perioperative period in patients taking anticoagulants ranges from 0.2 % to 0.4 % [33][34][35]. A short withdrawal period for anticoagulants under the JGES guideline may be feasible to minimize thromboembolic events.…”

Section: E1658mentioning

confidence: 99%

Effect of anticoagulants on the risk of delayed bleeding after colorectal endoscopic submucosal dissection

et al. 2020

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Background and study aims In patients receiving antithrombotic therapy, the risks of delayed bleeding after endoscopic procedures for gastrointestinal neoplasms become a major problem. Few reports have shown the effects of delayed bleeding in patients taking anticoagulants after colorectal endoscopic submucosal dissection (ESD). This study aimed to evaluate the delayed bleeding events after colorectal ESD in patients receiving anticoagulant therapy. Patients and methods We retrospectively analyzed 87 patients taking anticoagulants who underwent colorectal ESD from April 2012 to December 2017 at 13 Japanese institutions participating in the Osaka Gut Forum. Among these patients, warfarin users were managed with heparin bridge therapy (HBT), continued use of warfarin, a temporary switch to direct oral anticoagulation (DOAC), or withdrawal of warfarin, and DOAC users were managed with DOAC discontinuation with or without HBT. We investigated the occurrence rate of delayed bleeding and compared the rates between warfarin and DOAC users. Results The delayed bleeding rate was 17.2 % among all patients. The delayed bleeding rate was higher in DOAC users than in warfarin users (23.3 % vs. 11.4 %, P = 0.14), although no statistically significant difference was observed. In DOAC users, the delayed bleeding rates for dabigatran, rivaroxaban, apixaban, and edoxaban users appeared similar (30 %, 18.2 %, 22.2 %, and 25 %, respectively). The onset of delayed bleeding in both warfarin and DOAC users was late, averaging 6.9 and 9.4 days, respectively. Conclusions Among patients taking anticoagulants, the risk of delayed bleeding after colorectal ESD was relatively high and the onset of delayed bleeding was late.

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“…DOI: 10.1159/000504597 23]. Moreover, it was reported that heparin replacement therapy in DOACs patients did not prevent thromboembolism and increased the risk of bleeding events [24,25]. Without heparin replacement therapy, the temporary short interruption of DOACs in perioperative period of ESD did not increase thromboembolic events [25].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Effects of Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment on Postoperative Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matching Analysis

Terasaki¹,

Dohi²,

Naito³

et al. 2019

Digestion

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Background: Management of antithrombotic agents during endoscopic treatment changed after the publishing of Japan Gastroenterological Endoscopy Society guidelines for gastroenterological endoscopy in antithrombotic drug users (GL-2012). Objectives: We aimed to evaluate the effect of implementing antithrombotic agent management guidelines (GL-2012) on postoperative bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and on the prevention of thromboembolic events. Methods: A total of 1,264 patients who underwent ESD for EGC at Kyoto Prefectural University Hospital between June 2002 and March 2017 were enrolled and divided into 2 groups: 621 patients before the publication of GL-2012 (Pre-GL group) and 643 patients after (Post-GL group). Relationships between postoperative bleeding and various clinicopathological factors in each group were investigated through propensity score-matching analysis. Results: In the Pre-GL group, antihypertensive agent use (p < 0.01) and upper third of the stomach (p < 0.01) were significantly related to postoperative bleeding in univariate analysis. Antihypertensive agent use (OR 4.6, 95% CI 1.6–12.8) and upper third of the stomach (OR 4.9, 95% CI 1.8–13.4) were significantly related to postoperative bleeding in multivariate analysis. In the Post-GL group, antihypertensive agent use (p < 0.01), dual antiplatelet agents use (p < 0.01), anticoagulant agents use (p < 0.01), and heparin replacement therapy (p < 0.01) were significantly related to postoperative bleeding in univariate analysis. Antihypertensive agent use (OR 3.4, 95% CI 1.1–9.6), dual antiplatelet agents (OR 12.3, 95% CI 2.4–63.0), and heparin replacement therapy (OR 10.2, 95% CI 2.5–41.5) were significantly related to postoperative bleeding in multivariate analysis. Conclusions: The adherence to GL-2012 might reduce risk of thromboembolic events. On the other hand, dual antiplatelet agents therapy and heparin replacement therapy were the new independent risk factors for ESD postoperative bleeding in EGC after GL-2012. Especially as for heparin replacement therapy, uninterrupted warfarin or a temporary short interruption of direct oral anticoagulants without heparin replacement therapy might be recommended rather than heparin replacement therapy.

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Sa1035 Periendoscopic Management of Direct Oral Anticoagulants: A Prospective Cohort Study

Cited by 14 publications

References 0 publications

Intra‐procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study

Intra‐procedural and delayed bleeding after resection of large colorectal lesions: The SCALP study

Effect of anticoagulants on the risk of delayed bleeding after colorectal endoscopic submucosal dissection

Effects of Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment on Postoperative Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matching Analysis

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