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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1654-E1663
DOI: 10.1055/a-1244-2097
Original article

Effect of anticoagulants on the risk of delayed bleeding after colorectal endoscopic submucosal dissection

Hideharu Ogiyama
 1   Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Japan
,
Takuya Inoue
 2   Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
,
Akira Maekawa
 3   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Shunsuke Yoshii
 4   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Shinjiro Yamaguchi
 5   Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan
,
Kengo Nagai
 6   Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Suita, Japan
,
Masashi Yamamoto
 7   Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
,
Satoshi Egawa
 8   Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan
,
Masayoshi Horimoto
 9   Department of Gastroenterology, Saiseikai Senri Hospital, Suita, Japan
,
Hiroyuki Ogawa
10   Department of Gastroenterology, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
,
Akihiro Nishihara
11   Department of Gastroenterology, Minoh City Hospital, Minoh, Japan
,
Masato Komori
12   Department of Gastroenterology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
,
Takashi Kizu
13   Department of Gastroenterology, Yao Municipal Hospital, Yao, Japan
,
Shusaku Tsutsui
 1   Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Japan
,
Yoshiki Tsujii
 4   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Yoshito Hayashi
 4   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Hideki Iijima
 4   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Tetsuo Takehara
 4   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
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Abstract

Background and study aims In patients receiving antithrombotic therapy, the risks of delayed bleeding after endoscopic procedures for gastrointestinal neoplasms become a major problem. Few reports have shown the effects of delayed bleeding in patients taking anticoagulants after colorectal endoscopic submucosal dissection (ESD). This study aimed to evaluate the delayed bleeding events after colorectal ESD in patients receiving anticoagulant therapy.

Patients and methods We retrospectively analyzed 87 patients taking anticoagulants who underwent colorectal ESD from April 2012 to December 2017 at 13 Japanese institutions participating in the Osaka Gut Forum. Among these patients, warfarin users were managed with heparin bridge therapy (HBT), continued use of warfarin, a temporary switch to direct oral anticoagulation (DOAC), or withdrawal of warfarin, and DOAC users were managed with DOAC discontinuation with or without HBT. We investigated the occurrence rate of delayed bleeding and compared the rates between warfarin and DOAC users.

Results The delayed bleeding rate was 17.2 % among all patients. The delayed bleeding rate was higher in DOAC users than in warfarin users (23.3 % vs. 11.4 %, P = 0.14), although no statistically significant difference was observed. In DOAC users, the delayed bleeding rates for dabigatran, rivaroxaban, apixaban, and edoxaban users appeared similar (30 %, 18.2 %, 22.2 %, and 25 %, respectively). The onset of delayed bleeding in both warfarin and DOAC users was late, averaging 6.9 and 9.4 days, respectively.

Conclusions Among patients taking anticoagulants, the risk of delayed bleeding after colorectal ESD was relatively high and the onset of delayed bleeding was late.



Publication History

Received: 22 May 2020

Accepted: 30 July 2020

Article published online:
22 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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