Anticoagulants is a risk factor for delayed bleeding after colorectal endoscopic submucosal dissection: A HASID multicenter study

Aims Delayed bleeding is an important adverse event after colorectal endoscopic submucosal dissection (ESD). However, there is debate as to whether anticoagulants are a risk factor for delayed bleeding after colorectal ESD.

Methods We retrospectively analyzed 1,708 patients who undergoing colorectal ESD from January 2015 to December 2020 in five academic medical centers. We aimed to identify risk factors for delayed bleeding in patients after colonic ESD and, in particular, to evaluate the effect of anticoagulants.

Results Delayed bleeding occurred in 40 of 1,708 (2.3%) patients. The risk factors of delayed bleeding were antithrombotic agents (Odds ratio [OR], 6.155; 95% confidence intervals [CI], 3.201-11.825; p<0.001), antiplatelet agents (OR, 4.609; 95% CI, 2.200-9.658; p<0.001), anticoagulants (OR, 8.286; 95% CI, 2.934-23.402; p<0.001) and tumor location in the rectum (OR, 2.055; 95% CI, 1.085-3.897; p=0.027). In the analysis excluding patients taking antiplatelet agents, the delayed bleeding rate was also higher in patients taking anticoagulants (1.6% no antithrombotic agent vs 12.5% taking anticoagulants, p<0.001). There was no difference in delayed bleeding rate (4.2% direct oral anticoagulants vs 25.0% warfarin, p=0.138) and clinical outcomes according to the type of anticoagulants

Conclusions Anticoagulants use was a risk factor for delayed bleeding after colonic ESD, and there was no difference in the risk of delayed bleeding based on the type of anticoagulants. Caution should be exercised when performing colorectal ESDs in patients receiving anticoagulants.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
15 April 2024