Veeravich Jaruvongvanich1,2, Tomoki Sempokuya3, Karn Wijarnpreecha4, Patompong Ungprasert5. 1. Department of Internal Medicine, University of Hawaii, Honolulu, HI, 96817, USA. veeravich_j@hotmail.com. 2. Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. veeravich_j@hotmail.com. 3. Department of Internal Medicine, University of Hawaii, Honolulu, HI, 96817, USA. 4. Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA. 5. Division of Clinical Epidemiology, Siriraj Medical Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract
PURPOSE: Peri-procedural heparin is recommended as bridging therapy for patients with high thromboembolic risk who need to withhold anticoagulant for endoscopic submucosal dissection (ESD) for gastric neoplasms. However, little is known about the bleeding risk from heparin-bridging therapy itself. METHODS: MEDLINE and EMBASE databases were searched through August 2017 for studies that compared the risk of post-ESD bleeding in patients who received heparin-bridging therapy in lieu of anticoagulant for gastric neoplasms and those who discontinued anticoagulant without receiving heparin. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effect model, generic inverse variance method. The between-study heterogeneity was quantified using the Q statistic and I2. RESULTS: A total of four studies consisting of 350 patients were identified. A significantly increased risk of post-ESD bleeding among the bridged patients compared with the non-bridged patients was observed with the pooled RR of 2.99 (95% CI, 1.51 to 5.92). The statistical heterogeneity was insignificant with I2 of 0%. CONCLUSIONS: A significantly increased risk of post-ESD bleeding among patients who received heparin-bridging therapy in lieu of anticoagulant compared to patients who did not receive it was demonstrated in this study.
PURPOSE: Peri-procedural heparin is recommended as bridging therapy for patients with high thromboembolic risk who need to withhold anticoagulant for endoscopic submucosal dissection (ESD) for gastric neoplasms. However, little is known about the bleeding risk from heparin-bridging therapy itself. METHODS: MEDLINE and EMBASE databases were searched through August 2017 for studies that compared the risk of post-ESD bleeding in patients who received heparin-bridging therapy in lieu of anticoagulant for gastric neoplasms and those who discontinued anticoagulant without receiving heparin. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effect model, generic inverse variance method. The between-study heterogeneity was quantified using the Q statistic and I2. RESULTS: A total of four studies consisting of 350 patients were identified. A significantly increased risk of post-ESD bleeding among the bridged patients compared with the non-bridged patients was observed with the pooled RR of 2.99 (95% CI, 1.51 to 5.92). The statistical heterogeneity was insignificant with I2 of 0%. CONCLUSIONS: A significantly increased risk of post-ESD bleeding among patients who received heparin-bridging therapy in lieu of anticoagulant compared to patients who did not receive it was demonstrated in this study.
Authors: Ahmedin Jemal; Melissa M Center; Carol DeSantis; Elizabeth M Ward Journal: Cancer Epidemiol Biomarkers Prev Date: 2010-07-20 Impact factor: 4.254
Authors: Joseph P Broderick; Jordan B Bonomo; Brett M Kissela; Jane C Khoury; Charles J Moomaw; Kathleen Alwell; Daniel Woo; Matthew L Flaherty; Pooja Khatri; Opeolu Adeoye; Simona Ferioli; Dawn O Kleindorfer Journal: Stroke Date: 2011-06-30 Impact factor: 7.914
Authors: Jaffer A Ajani; Thomas A D'Amico; Khaldoun Almhanna; David J Bentrem; Joseph Chao; Prajnan Das; Crystal S Denlinger; Paul Fanta; Farhood Farjah; Charles S Fuchs; Hans Gerdes; Michael Gibson; Robert E Glasgow; James A Hayman; Steven Hochwald; Wayne L Hofstetter; David H Ilson; Dawn Jaroszewski; Kimberly L Johung; Rajesh N Keswani; Lawrence R Kleinberg; W Michael Korn; Stephen Leong; Catherine Linn; A Craig Lockhart; Quan P Ly; Mary F Mulcahy; Mark B Orringer; Kyle A Perry; George A Poultsides; Walter J Scott; Vivian E Strong; Mary Kay Washington; Benny Weksler; Christopher G Willett; Cameron D Wright; Debra Zelman; Nicole McMillian; Hema Sundar Journal: J Natl Compr Canc Netw Date: 2016-10 Impact factor: 11.908
Authors: Daniel M Witt; Thomas Delate; David A Garcia; Nathan P Clark; Elaine M Hylek; Walter Ageno; Francesco Dentali; Mark A Crowther Journal: Arch Intern Med Date: 2012-10-22