A prospective multicenter observational study evaluating the risk of periendoscopic events in patients using anticoagulants: the Osaka GIANT Study

Abstract

Background and study aims An increasing number of patients have been using anticoagulants including anti-vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs); however, in patients using anticoagulants, limited data are available with regard to the risks of gastrointestinal bleeding and thromboembolic events during the peri-endoscopic period. We aimed to evaluate the peri-endoscopic bleeding and thrombotic risks in patients administered VKAs or DOACs. Patients and methods Consecutive patients using anticoagulants who underwent endoscopic biopsy, mucosal resection, or submucosal dissection were prospectively enrolled across 11 hospitals. The primary outcome assessed was difference in incidence of post-procedural gastrointestinal bleeding in patients using VKAs and DOACs. Duration of hospitalization and peri-procedural thromboembolic events were also compared. Results We enrolled 174 patients using VKAs and 37 using DOACs. In total, 16 patients using VKA were excluded from the analysis because of cancellation of endoscopic procedures and contraindications to the use of DOACs; 128 (81 %) patients using VKAs and 17 (46 %) using DOACs received heparin-bridging therapy (HB). The rate of post-procedural gastrointestinal bleeding in DOAC users was similar to that in VKA users (16.2 % vs. 16.4 %, P = 1.000). Duration of hospitalization was significantly longer in patients using VKAs than in those using DOACs (median 15 vs. 7 days, P < 0.0001). Myocardial infarction occurred during pre-endoscopic HB in one patient using VKAs. Conclusion DOAC administration showed similar post-procedural gastrointestinal bleeding risk to VKA administration in patients undergoing endoscopic procedures, but it shortened the hospital stay.

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

“…Detailed information about the excluded studies is presented in the supporting information. Eventually, 30 articles were included 24–53 …”

“…The study characteristics are presented in Table 1. Four studies were prospective studies or randomized controlled trial (RCT), 26,33,37,48 whereas the others were retrospective. In total, the studies enrolled 20 079 patients, of whom 5786 received DOACs and 14 293 received warfarin.…”

“…Others were conducted in Japan. Ten studies focused on PPB of DOACs and warfarin in ESD 24,25,27,29,37,40,41,43,46,50 . Only two studies mentioned the usage of epinephrine as injection solution 50,53 .…”

“…Only two studies mentioned the usage of epinephrine as injection solution 50,53 . As for the types of DOACs, 14 (46.67%) studies included dabigatran, rivaroxaban, apixaban, and edoxaban 24–28,32–38,41,43 . And five studies reported that the duration of withdrawal of antithrombotic agents was determined according to the guidelines published by the JGES 24,25,28,31,44 .…”

“…And five studies reported that the duration of withdrawal of antithrombotic agents was determined according to the guidelines published by the JGES 24,25,28,31,44 . For DOACs, HB was applied in 17 studies 24,25,27,29,31–34,36,37,39,42,45,46,48,50,52 . Six studies just discontinued DOACs before the endoscopic procedures without the usage of HB 26,28,35,40,41,49 .…”