Hideomi Tomida1,2, Toshiyuki Yoshio3, Kimihiro Igarashi4, Yoshinori Morita5, Ichiro Oda6, Takuya Inoue7, Takuto Hikichi8, Tetsuya Sumiyoshi9, Hisashi Doyama10, Yosuke Tsuji11, Jun Nishikawa12, Waku Hatta13, Tatsuya Mikami14, Mikitaka Iguchi15, Kazuki Sumiyama16, Katsumi Yamamoto17, Kazuya Kitamura18, Shiko Kuribayashi19, Atsushi Yanagitani20, Toshio Uraoka21, Tomoyuki Yada22, Kenkei Hasatani23, Koichiro Kawaguchi24, Tomoki Fujita25, Tsutomu Nishida26, Yoichi Hiasa1, Mitsuhiro Fujishiro27. 1. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, 7910295, Japan. 2. Gastroenterology Center, Ehime Prefectural Central Hospital, Kasugamachi 83, Matsuyama, 7900024, Japan. 3. Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 1358550, Japan. toshiyuki.yoshio@jfcr.or.jp. 4. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 4118777, Japan. 5. Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan. 6. Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan. 7. Division of Gastroenterology and Hepatology, Osaka General Medical Center, 3-1-56 Bandai-higashi, Sumiyoshi-ku, Osaka, 5588558, Japan. 8. Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 9601295, Japan. 9. Department of Gastroenterology, Tonan Hospital, 3-8 Kita4-Nishi7, Chuo-ku, Sapporo, 0600004, Japan. 10. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi, Kanazawa, 9208530, Japan. 11. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655, Japan. 12. Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, 7558505, Japan. 13. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 9808574, Japan. 14. Division of Endoscopy, Hirosaki University Hospital, 53 Honcho, Hirosaki, 0368563, Japan. 15. Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 6410012, Japan. 16. Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 1058461, Japan. 17. Department of Gastroenterology, JCHO Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka, 5530003, Japan. 18. Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 9208641, Japan. 19. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, 3718511, Japan. 20. Department of Gastroenterology, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, 6800901, Japan. 21. Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 1528902, Japan. 22. Division of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, 2728516, Japan. 23. Department of Gastroenterology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, 9108526, Japan. 24. Department of Gastroenterology, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, 6838504, Japan. 25. Department of Gastroenterology, Otaru Ekisaikai Hospital, 1-4-1 Inaho, Otaru, 0470032, Japan. 26. Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, 5608565, Japan. 27. Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Abstract
BACKGROUND AND AIMS: Delayed bleeding after gastric endoscopic submucosal dissection (ESD) in patients receiving anticoagulants remains an unpreventable adverse event. Although direct-acting oral anticoagulants (DOACs) have superior efficacy in preventing thromboembolism, their effects on the occurrence of delayed bleeding remain unclear. This study aimed to elucidate the clinical effect of DOACs on delayed bleeding after gastric ESD. PATIENTS AND METHODS: We retrospectively examined 728 patients who received anticoagulants and were treated for gastric neoplasms with ESD in 25 institutions across Japan. Overall, 261 patients received DOACs, including dabigatran (92), rivaroxaban (103), apixaban (45) and edoxaban (21), whereas 467 patients were treated with warfarin. RESULTS: Delayed bleeding occurred in 14% of patients taking DOACs, which was not considerably different in patients receiving warfarin (18%). Delayed bleeding rate was significantly lower in patients receiving dabigatran than in those receiving warfarin and lower than that observed for other DOACs. Multivariate analysis showed that age ≥ 65, receiving multiple antithrombotic agents, resection of multiple lesions and lesion size ≥ 30 mm were independent risk factors, and that discontinuation of anticoagulants was associated with a decreased risk of bleeding. In multivariate analysis among patients taking DOACs, dabigatran therapy was associated with a significantly lower risk of delayed bleeding. CONCLUSIONS: The effects of DOACs on delayed bleeding varied between agents, but dabigatran therapy was associated with the lowest risk of delayed bleeding. Switching oral anticoagulants to dabigatran during the perioperative period could be a reasonable option to reduce the risk of delayed bleeding after gastric ESD.
BACKGROUND AND AIMS: Delayed bleeding after gastric endoscopic submucosal dissection (ESD) in patients receiving anticoagulants remains an unpreventable adverse event. Although direct-acting oral anticoagulants (DOACs) have superior efficacy in preventing thromboembolism, their effects on the occurrence of delayed bleeding remain unclear. This study aimed to elucidate the clinical effect of DOACs on delayed bleeding after gastric ESD. PATIENTS AND METHODS: We retrospectively examined 728 patients who received anticoagulants and were treated for gastric neoplasms with ESD in 25 institutions across Japan. Overall, 261 patients received DOACs, including dabigatran (92), rivaroxaban (103), apixaban (45) and edoxaban (21), whereas 467 patients were treated with warfarin. RESULTS:Delayed bleeding occurred in 14% of patients taking DOACs, which was not considerably different in patients receiving warfarin (18%). Delayed bleeding rate was significantly lower in patients receiving dabigatran than in those receiving warfarin and lower than that observed for other DOACs. Multivariate analysis showed that age ≥ 65, receiving multiple antithrombotic agents, resection of multiple lesions and lesion size ≥ 30 mm were independent risk factors, and that discontinuation of anticoagulants was associated with a decreased risk of bleeding. In multivariate analysis among patients taking DOACs, dabigatran therapy was associated with a significantly lower risk of delayed bleeding. CONCLUSIONS: The effects of DOACs on delayed bleeding varied between agents, but dabigatran therapy was associated with the lowest risk of delayed bleeding. Switching oral anticoagulants to dabigatran during the perioperative period could be a reasonable option to reduce the risk of delayed bleeding after gastric ESD.
Authors: Xiaoxi Yao; Neena S Abraham; Lindsey R Sangaralingham; M Fernanda Bellolio; Robert D McBane; Nilay D Shah; Peter A Noseworthy Journal: J Am Heart Assoc Date: 2016-06-13 Impact factor: 5.501
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