Taking Warfarin with Heparin Replacement and Direct Oral Anticoagulant Is a Risk Factor for Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer.

Although bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) remains problematic, especially in patients taking anticoagulants, there are differing views on the ideal and optimal management for these patients. This study investigated the risk of bleeding after ESD in patients taking anticoagulants. We enrolled 61 consecutive patients taking anticoagulants (anticoagulant group) and 968 patients taking no antithrombotic agents (non-antithrombotic group) treated with ESD for EGC between December 2010 and October 2016. We analyzed the risk factors for bleeding after ESD in relation to the various clinical factors. Incidences of bleeding after ESD were significantly higher (14%; 11/76) in the anticoagulant group compared to the non-antithrombotic group (3%; 40/1,167). Moreover, bleeding after ESD was significantly more common in patients in the warfarin monotherapy group (14%; 5/37) and in the direct oral anticoagulant (DOAC) monotherapy group (22%; 4/18), compared to the non-antithrombotic group. Multivariate analysis revealed that dialysis, the use of anticoagulants, and an operation time ≥75 min were independent risk factors for bleeding after ESD. Our data suggest that patients who take warfarin and receive heparin bridging, and those who take DOAC medication, are prone to bleeding after ESD for EGC.

Sanomura Y ，Oka S ，Tanaka S ，Yorita N ，Kuroki K ，Kurihara M ，Mizumoto T ，Yoshifuku Y ，Chayama K ... -  《-》

Effect of direct oral anticoagulants on the risk of delayed bleeding after gastric endoscopic submucosal dissection.

Anticoagulants are used to prevent thromboembolic events. Direct oral anticoagulants (DOAC) are our new choice; however, their effect on bleeding risk for endoscopic treatment has not been reported. We aimed to assess the clinical effect of DOAC compared to warfarin for gastric endoscopic submucosal dissection (ESD). We retrospectively studied 97 patients on anticoagulants and treated 108 gastric neoplasms with ESD in three referral institutes. Twenty-four patients were taking DOAC, including dabigatran (12), rivaroxaban (11), and apixaban (one) and 73 were taking warfarin. In the DOAC group, delayed bleeding rate was significantly higher in patients on rivaroxaban than in patients on dabigatran (45% vs 0%, P < 0.05) without relation to heparin bridge therapy (HBT). In the warfarin group, 78% of patients underwent HBT, and delayed bleeding rate was significantly higher in patients with HBT than in those without (36% vs 0%, P < 0.05). Delayed bleeding rate increased as intake of antithrombotic agents increased (P < 0.05). HBT period was shorter (P < 0.05) in DOAC because DOAC achieve the maximum effect quicker, and hospitalization period was shorter (P < 0.05), compared with warfarin. Multivariate analysis showed that HBT (OR, 10.7), rivaroxaban (OR, 6.00) and multiple antithrombotic agents (OR, 4.35) were independent delayed bleeding risk factors. The DOAC effect differs in each agent. Dabigatran is a feasible alternative to warfarin for shortening the hospitalization period and decreasing delayed bleeding rate, although rivaroxaban has a significantly higher delayed bleeding risk.

Yoshio T ，Tomida H ，Iwasaki R ，Horiuchi Y ，Omae M ，Ishiyama A ，Hirasawa T ，Yamamoto Y ，Tsuchida T ，Fujisaki J ，Yamada T ，Mita E ，Ninomiya T ，Michitaka K ，Igarashi M ... -  《-》

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

Hamada K ，Kanzaki H ，Inoue M ，Ishiyama S ，Yamauchi K ，Miyahara K ，Toyokawa T ，Tsuzuki T ，Miyaike J ，Matsubara M ，Takahashi S ，Nishimura M ，Takenaka R ，Yunoki N ，Hori S ，Kobayashi S ，Yamasaki Y ，Kawahara Y ，Ishikawa H ，Okada H ... -  《-》

Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection.

Sato C ，Hirasawa K ，Koh R ，Ikeda R ，Fukuchi T ，Kobayashi R ，Kaneko H ，Makazu M ，Maeda S ... -  《-》

Risk Factors for Post-gastric Endoscopic Submucosal Dissection Bleeding with a Special Emphasis on Anticoagulant Therapy.

Toya Y ，Endo M ，Oizumi T ，Akasaka R ，Yanai S ，Kawasaki K ，Nakamura S ，Eizuka M ，Fujita Y ，Uesugi N ，Sugai T ，Matsumoto T ... -  《-》