Effect of direct oral anticoagulants on the risk of delayed bleeding after gastric endoscopic submucosal dissection
Corresponding Author
Toshiyuki Yoshio
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Corresponding: Toshiyuki Yoshio, Department of Gastroenterology Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan. Email: [email protected]Search for more papers by this authorHideomi Tomida
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan
Search for more papers by this authorRyuichiro Iwasaki
Department of Gastroenterology, Osaka National Hospital, Osaka, Japan
Search for more papers by this authorYusuke Horiuchi
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorMasami Omae
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorAkiyoshi Ishiyama
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorToshiaki Hirasawa
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorYorimasa Yamamoto
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorTomohiro Tsuchida
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorJunko Fujisaki
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorTakuya Yamada
Department of Gastroenterology, Osaka National Hospital, Osaka, Japan
Search for more papers by this authorEiji Mita
Department of Gastroenterology, Osaka National Hospital, Osaka, Japan
Search for more papers by this authorTomoyuki Ninomiya
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan
Search for more papers by this authorKojiro Michitaka
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan
Search for more papers by this authorMasahiro Igarashi
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Toshiyuki Yoshio
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Corresponding: Toshiyuki Yoshio, Department of Gastroenterology Cancer Institute Hospital, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan. Email: [email protected]Search for more papers by this authorHideomi Tomida
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan
Search for more papers by this authorRyuichiro Iwasaki
Department of Gastroenterology, Osaka National Hospital, Osaka, Japan
Search for more papers by this authorYusuke Horiuchi
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorMasami Omae
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorAkiyoshi Ishiyama
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorToshiaki Hirasawa
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorYorimasa Yamamoto
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorTomohiro Tsuchida
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorJunko Fujisaki
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorTakuya Yamada
Department of Gastroenterology, Osaka National Hospital, Osaka, Japan
Search for more papers by this authorEiji Mita
Department of Gastroenterology, Osaka National Hospital, Osaka, Japan
Search for more papers by this authorTomoyuki Ninomiya
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan
Search for more papers by this authorKojiro Michitaka
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan
Search for more papers by this authorMasahiro Igarashi
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorAbstract
Background and Aim
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).
Methods
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.
Results
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.
Conclusions
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.
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