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

Hideharu Ogiyama; Takuya Inoue; Akira Maekawa; Shunsuke Yoshii; Shinjiro Yamaguchi; Kengo Nagai; Masashi Yamamoto; Satoshi Egawa; Masayoshi Horimoto; Hiroyuki Ogawa; Akihiro Nishihara; Masato Komori; Takashi Kizu; Shusaku Tsutsui; Yoshiki Tsujii; Yoshito Hayashi; Hideki Iijima; Tetsuo Takehara

doi:10.1055/a-1244-2097

Endoscopy International Open, Table of Contents

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

¹Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Japan

,

Takuya Inoue

²Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan

,

Akira Maekawa

³Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Shunsuke Yoshii

⁴Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan

,

Shinjiro Yamaguchi

⁵Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Japan

,

Kengo Nagai

⁶Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Suita, Japan

,

Masashi Yamamoto

⁷Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan

,

Satoshi Egawa

⁸Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan

,

Masayoshi Horimoto

⁹Department of Gastroenterology, Saiseikai Senri Hospital, Suita, Japan

,

Hiroyuki Ogawa

¹⁰Department of Gastroenterology, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan

,

Akihiro Nishihara

¹¹Department of Gastroenterology, Minoh City Hospital, Minoh, Japan

,

Masato Komori

¹²Department of Gastroenterology, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan

,

Takashi Kizu

¹³Department of Gastroenterology, Yao Municipal Hospital, Yao, Japan

,

Shusaku Tsutsui

¹Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Japan

,

Yoshiki Tsujii

⁴Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan

,

Yoshito Hayashi

⁴Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan

,

Hideki Iijima

⁴Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan

,

Tetsuo Takehara

⁴Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan

› Author Affiliations

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.

Full Text

References

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