Kimitoshi Kubo1, Mototsugu Kato2, Katsuhiro Mabe2, Naohiko Harada3, Yoichiro Iboshi3, Takashi Kagaya4, Masayoshi Ono5, Tatsuya Toyokawa6, Haruhiro Yamashita7, Toshio Kuwai8, Hiroshige Hamada9, Yuko Sakakibara10, Hitoshi Nishiyama11, Nobuyuki Ara12, Hideki Mori13, Mio Matsumoto14, Yasuo Takahashi15, Shinji Katsushima16, Noriko Watanabe17, Yoshito Ogura18, Hiroki Saito19, Eiji Masuda20, Toraji Amano21. 1. Departments of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan, kubotti25@yahoo.co.jp. 2. Departments of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan. 3. Departments of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan. 4. Departments of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan. 5. Departments of Gastroenterology, Hakodate Municipal Hospital, Hakodate, Japan. 6. Departments of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan. 7. Departments of Gastroenterology, National Hospital Organization Okayama Medical Center, Okayama, Japan. 8. Departments of Gastroenterology, National Hospital Organization Kure Medical Center, Kure, Japan. 9. Departments of Gastroenterology, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan. 10. Departments of Gastroenterology, National Hospital Organization Osaka Medical Center, Osaka, Japan. 11. Departments of Gastroenterology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan. 12. Departments of Gastroenterology, National Hospital Organization Sendai Medical Center, Sendai, Japan. 13. Departments of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. 14. Departments of Gastroenterology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan. 15. Departments of Gastroenterology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan. 16. Departments of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 17. Departments of Gastroenterology, Mie Central Medical Center, Tsu, Japan. 18. Departments of Gastroenterology, Minamikyushu National Hospital, Aira, Japan. 19. Departments of Gastroenterology, National Hospital Organization Asahikawa Medical Center, Asahikawa, Japan. 20. Departments of Gastroenterology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan. 21. Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan.
Abstract
BACKGROUND/AIMS: Delayed bleeding is among the adverse events associated with therapeutic gastrointestinal endoscopy. The aim of this study was to evaluate risk factors for delayed bleeding after gastrointestinal endoscopic resection in patients receiving oral anticoagulants as well as to compare the rates of occurrence of delayed bleeding between the oral anticoagulants used. METHODS: We retrospectively analyzed a total of 772 patients receiving anticoagulants. Of these, 389 and 383 patients were receiving direct oral anticoagulants (DOACs) and warfarin, respectively. Therapeutic endoscopic procedures performed included endoscopic submucosal dissection (ESD), endoscopic mucosal resection, polypectomy, and cold polypectomy. RESULTS: Delayed bleeding occurred in 90 patients (11.7%) with no significant difference between the DOAC and warfarin groups (9.5 and 13.8%, respectively). Delayed bleeding occurred significantly more frequently with apixaban than with rivaroxaban (13.5 vs. 6.4%; p < 0.05). A multivariate analysis identified continued anticoagulant therapy (OR 2.29), anticoagulant withdrawal with heparin bridging therapy (HBT; OR 2.18), anticoagulant therapy combined with 1 antiplatelet drug (OR 1.72), and ESD (OR 3.87) as risk factors for delayed bleeding. CONCLUSION: This study identified continued anticoagulant therapy, anticoagulant withdrawal with HBT, anticoagulant therapy combined with 1 antiplatelet drug, and ESD as risk factors for delayed bleeding after therapeutic endoscopy in patients receiving oral anticoagulants. Delayed bleeding rates were not significantly different between those receiving DOACs and warfarin. It was also suggested that the occurrence of delayed bleeding may vary between different DOACs and that oral anticoagulant withdrawal should be minimized during therapeutic gastrointestinal endoscopy, given the thromboembolic risk involved.
BACKGROUND/AIMS: Delayed bleeding is among the adverse events associated with therapeutic gastrointestinal endoscopy. The aim of this study was to evaluate risk factors for delayed bleeding after gastrointestinal endoscopic resection in patients receiving oral anticoagulants as well as to compare the rates of occurrence of delayed bleeding between the oral anticoagulants used. METHODS: We retrospectively analyzed a total of 772 patients receiving anticoagulants. Of these, 389 and 383 patients were receiving direct oral anticoagulants (DOACs) and warfarin, respectively. Therapeutic endoscopic procedures performed included endoscopic submucosal dissection (ESD), endoscopic mucosal resection, polypectomy, and cold polypectomy. RESULTS:Delayed bleeding occurred in 90 patients (11.7%) with no significant difference between the DOAC and warfarin groups (9.5 and 13.8%, respectively). Delayed bleeding occurred significantly more frequently with apixaban than with rivaroxaban (13.5 vs. 6.4%; p < 0.05). A multivariate analysis identified continued anticoagulant therapy (OR 2.29), anticoagulant withdrawal with heparin bridging therapy (HBT; OR 2.18), anticoagulant therapy combined with 1 antiplatelet drug (OR 1.72), and ESD (OR 3.87) as risk factors for delayed bleeding. CONCLUSION: This study identified continued anticoagulant therapy, anticoagulant withdrawal with HBT, anticoagulant therapy combined with 1 antiplatelet drug, and ESD as risk factors for delayed bleeding after therapeutic endoscopy in patients receiving oral anticoagulants. Delayed bleeding rates were not significantly different between those receiving DOACs and warfarin. It was also suggested that the occurrence of delayed bleeding may vary between different DOACs and that oral anticoagulant withdrawal should be minimized during therapeutic gastrointestinal endoscopy, given the thromboembolic risk involved.
Authors: Andrew M Veitch; Franco Radaelli; Raza Alikhan; Jean-Marc Dumonceau; Diane Eaton; Jo Jerrome; Will Lester; David Nylander; Mo Thoufeeq; Geoffroy Vanbiervliet; James R Wilkinson; Jeanin E van Hooft Journal: Endoscopy Date: 2021-08-06 Impact factor: 10.093
Authors: Andrew M Veitch; Franco Radaelli; Raza Alikhan; Jean Marc Dumonceau; Diane Eaton; Jo Jerrome; Will Lester; David Nylander; Mo Thoufeeq; Geoffroy Vanbiervliet; James R Wilkinson; Jeanin E Van Hooft Journal: Gut Date: 2021-09 Impact factor: 23.059