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

Sanomura, Yoji; Oka, Shiro; Tanaka, Shinji; Yorita, Naoki; Kuroki, Kazutaka; Kurihara, Mio; Mizumoto, Takeshi; Yoshifuku, Yoshikazu; Chayama, Kazuaki

doi:10.1159/000485026

Cited by 41 publications

(46 citation statements)

References 34 publications

(36 reference statements)

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“…As shown in Table , many studies have reported the risk factors of bleeding after ESD of gastric lesions . Based on the current research results, the risk factors can be classified into patient‐, tumor‐ and operation‐related factors.…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 97%

“…Therefore, it is essential to evaluate the association between bleeding risk and thromboembolism when antithrombotic drugs are being administered. Some studies reported that use of antithrombotic drug was a risk factor for hemorrhage after gastric ESD . Conversely, others showed that antithrombotic drugs did not increase such risk .…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

“…Takeuchi et al reported that anticoagulants could increase the incidence of post‐ESD hemorrhage. Sanomura et al conducted a retrospective study on post‐ESD bleeding of gastric lesions, showing that the anticoagulant group had a significantly higher risk of hemorrhage than the control group. These results suggest that anticoagulants, including warfarin and direct oral anticoagulants (DOAC), are risk factors for post‐ESD bleeding of gastric lesions.…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

“…CKD and hemodialysis have been shown to increase the incidence of hemorrhage after gastric ESD . Takahashi et al reported that patients with CKD had a significantly higher risk of post‐ESD hemorrhage compared with those without.…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

“…Takahashi et al reported that patients with CKD had a significantly higher risk of post‐ESD hemorrhage compared with those without. Sanomura et al revealed that hemodialysis increased the incidence of bleeding after ESD of gastric lesions. Healing of artificial ulcer caused by ESD may be delayed in patients with CKD due to fragile tissue, low albumin levels, blood vessel disease increased acid excretion and gastrin content, etc, thus leading to delayed histological recovery of ulcers and postoperative bleeding.…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

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Bleeding after endoscopic submucosal dissection of gastric lesions

Yang

Qiu

et al. 2020

J of Digest Diseases

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Endoscopic submucosal dissection (ESD) is generally used to treat gastric mucosal and submucosal lesions. Nevertheless, ESD is more difficult and complicated to perform than a traditional endoscopic mucosal resection, which can increase the incidence of various complications including hemorrhage, perforation and infection. Hemorrhage is a major post‐ESD complication. Prevention and early diagnosis of post‐ESD bleeding for gastric lesions are closely associated with the efficacy and safety of the operation. Many studies have reported the risks of and the preventative measures for hemorrhage after gastric ESD, but there remain some issues to be solved. We thus reviewed the risk factors, precautions and treatments for hemorrhage after ESD of gastric lesions.

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Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 97%

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

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Bleeding after endoscopic submucosal dissection of gastric lesions

Yang

Qiu

et al. 2020

J of Digest Diseases

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Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective study

et al. 2022

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Objectives In July 2017, supplementary guidelines on anticoagulants, including direct oral anticoagulants, were published in Japan. We investigated the changes in endoscopic submucosal dissection (ESD) of gastric mucosal lesions after the publication of the supplement, examined the risk factors, and developed a predictive model for post‐ESD bleeding. Methods We included 2272 gastric ESD cases from our hospital between May 2003 and June 2021 and classified them into two groups: 1789 cases before and 483 after the publication of the supplementary guidelines. A predictive model for post‐ESD bleeding was developed using the pre‐publication cohort data. Results The proportion of patients receiving warfarin decreased (5.0% vs. 1.4%) and those receiving direct oral anticoagulants increased (1.2% vs. 6.8%) after the publication of the supplementary guidelines. Post‐ESD bleeding occurred in 61 patients, but there was no significant difference in the bleeding rate between the groups (50 [2.8%] vs. 11 [2.3%] patients, respectively). Five risk factors (number of antithrombotic agents, dialysis, heparin replacement, resection specimen size, and procedure time) were identified for model development. The C‐statistic for the model and post‐publication cohorts were 0.83 and 0.72, respectively. In the model, each risk factor for postoperative bleeding was scored, and the risk was classified into three levels according to the total score. Bleeding rates at low, intermediate, and high risks were 1.6%, 10.3%, and 38.9%, respectively. Conclusion Despite changes in patient characteristics and clinical practice regarding ESD before and after the publication of the supplementary guidelines, we could still develop a simple and useful predictive model.

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