Continued use of low-dose aspirin may increase risk of bleeding after gastrointestinal endoscopic submucosal dissection: A meta-analysis

Wu, Wei; Chen, Jingdi; Ding, Qianshan; Yang, Dongmei; Yu, Honggang; Lin, Jie

doi:10.5152/tjg.2017.16573

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…However, continued aspirin treatment was identified to be a risk factor of delayed bleeding after gastric ESD under HR. Although it remains controversial as to whether continued aspirin treatment alone increases the bleeding risk after gastrointestinal ESD (12,13), and our results indicate an elevated risk of delayed bleeding with the co-use of HR and aspirin.…”

Section: Discussionmentioning

confidence: 57%

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

et al. 2020

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Objective Gastric endoscopic submucosal dissection (ESD) under heparin replacement (HR) of warfarin reportedly has a high risk of delayed bleeding (24-57%). It is possible that the delayed bleeding risk may have changed over the years. We evaluated the current risk of delayed bleeding after gastric ESD under HR of anticoagulant agents. Methods We retrospectively reviewed the delayed bleeding rate and analyzed the risk factors for delayed bleeding. Patients Consecutive patients who underwent gastric ESD under HR of anticoagulant agents from July 2015 to June 2017. Results A total of 32 patients with a solitary early gastric cancer and taking anticoagulant agents were analyzed, including 24 patients on warfarin (the warfarin group) and 8 patients on direct oral anticoagulants (the DOAC group). Three (9.4%) patients experienced delayed bleeding: three (12.5%) patients in the warfarin group and no patients in the DOAC group. Continued aspirin treatment was identified to be a risk factor of delayed bleeding (p=0.01). Conclusion Careful management may be required for patients undergoing gastric ESD under continued aspirin treatment in addition to HR of anticoagulant agents; although the delayed bleeding risk after gastric ESD under HR of anticoagulant agents might have decreased over the years.

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Section: Discussionmentioning

confidence: 57%

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

et al. 2020

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“…21,37,38 Several reports have suggested that continued aspirin treatment increases the risk of post-ESD bleeding in the stomach and colon compared with no antithrombotic drug and discontinued-aspirin treatments. 11,17,19 In contrast, the incidence of thrombotic events is 2.1% with aspirin discontinuation. 39 Therefore, the Japanese guidelines recommend continuing aspirin when there is a high risk for a thrombotic event and discontinuing when there is a low risk.…”

Section: Discussionmentioning

confidence: 99%

“…16 Aspirin, thienopyridine, direct oral anticoagulants (DOAC), and warfarin are considered antithrombotic drugs with a risk of bleeding. 11,[17][18][19][20] However, cessation of these drugs increases the risk of a thromboembolic event. 21 Therefore, this quandary is a Ethical approval: This study was performed in accordance with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of our hospital (no.…”

Section: Introductionmentioning

confidence: 99%

The effect of antithrombotic drug use on delayed bleeding with esophageal endoscopic resection

Horie

Horiuchi

Ishiyama

et al. 2022

J of Gastro and Hepatol

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Background and Aim Whether antithrombotic drugs increase the risk of post‐esophageal endoscopic resection bleeding is unknown. This study examined the effect of antithrombotic drugs, aspirin, thienopyridine, direct oral anticoagulants (DOAC), and warfarin, on post‐esophageal endoscopic resection bleeding. Methods We enrolled 957 patients (1202 esophageal tumors) treated with endoscopic resection and classified them based on antithrombotic drug use as no use, aspirin, thienopyridine, DOAC, and warfarin. Patients using antiplatelet drugs (i.e. aspirin and thienopyridine) were further sub‐classified based on their continued or discontinued use before endoscopic resection. The bleeding rates were compared between these groups to assess the effects of antithrombotic drug use and interruption of antiplatelet therapy on post‐esophageal endoscopic resection bleeding. Results The post‐endoscopic resection bleeding rate was 0.3% (95% CI, 0.1–1) in the group without antithrombotic drug use, 4.5% (95% CI, 0.1–23) in the aspirin‐continued group, 2.9% (95% CI, 0.1–15) in the aspirin‐discontinued group, 0% (95% CI, 0–78) in the replaced thienopyridine with aspirin group, 0% (95% CI, 0–26) in the thienopyridine‐discontinued group, 13% (95% CI, 1.6–38) in the DOAC group, and 0% (95% CI, 0–45) in the warfarin group. The post‐endoscopic resection bleeding rate in the DOAC group was significantly higher than that in the group without antithrombotic drugs (P = 0.003). The post‐endoscopic resection bleeding rates did not differ between the other groups. Conclusions Our results suggest that discontinuing aspirin is not necessary for esophageal endoscopic resection while we must be careful regarding DOAC.

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“…Aspirin did not increase the PEB risk after discontinuation about 1 wk[ 25 ]. Although some reported that maintaining aspirin did not increase the PEB risk[ 25 - 28 ], a meta-analysis showed that aspirin was associated with increased bleeding risk, requiring clinical caution[ 29 ]. There is still controversial due to limited evidence for P2Y12R[ 9 , 13 , 20 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Utility of a deep learning model and a clinical model for predicting bleeding after endoscopic submucosal dissection in patients with early gastric cancer

Na¹,

Lee²,

Kim³

et al. 2022

WJG

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BACKGROUND Bleeding is one of the major complications after endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) patients. There are limited studies on estimating the bleeding risk after ESD using an artificial intelligence system. AIM To derivate and verify the performance of the deep learning model and the clinical model for predicting bleeding risk after ESD in EGC patients. METHODS Patients with EGC who underwent ESD between January 2010 and June 2020 at the Samsung Medical Center were enrolled, and post-ESD bleeding (PEB) was investigated retrospectively. We split the entire cohort into a development set (80%) and a validation set (20%). The deep learning and clinical model were built on the development set and tested in the validation set. The performance of the deep learning model and the clinical model were compared using the area under the curve and the stratification of bleeding risk after ESD. RESULTS A total of 5629 patients were included, and PEB occurred in 325 patients. The area under the curve for predicting PEB was 0.71 (95% confidence interval: 0.63-0.78) in the deep learning model and 0.70 (95% confidence interval: 0.62-0.77) in the clinical model, without significant difference ( P = 0.730). The patients expected to the low- (< 5%), intermediate- (≥ 5%, < 9%), and high-risk (≥ 9%) categories were observed with actual bleeding rate of 2.2%, 3.9%, and 11.6%, respectively, in the deep learning model; 4.0%, 8.8%, and 18.2%, respectively, in the clinical model. CONCLUSION A deep learning model can predict and stratify the bleeding risk after ESD in patients with EGC.

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Continued use of low-dose aspirin may increase risk of bleeding after gastrointestinal endoscopic submucosal dissection: A meta-analysis

Cited by 6 publications

References 16 publications

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

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

The effect of antithrombotic drug use on delayed bleeding with esophageal endoscopic resection

Utility of a deep learning model and a clinical model for predicting bleeding after endoscopic submucosal dissection in patients with early gastric cancer

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