RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0034-1392018
Endoscopic submucosal dissection for early gastric cancer without interruption of warfarin and aspirin
Publikationsverlauf
submitted 28. September 2014
accepted after revision 05. März 2015
Publikationsdatum:
12. Juni 2015 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201504/lookinside/thumbnails/157_10-1055-s-0034-1392018-1.jpg)
Many guidelines for the management of antithrombotic therapy in endoscopic procedures state that warfarin should be replaced by heparin in high risk endoscopic procedures. However, heparin bridging therapy is costly, requires a long hospital stay, and is indicated as a risk factor for bleeding after endoscopic submucosal dissection (ESD). It is not yet clear whether it is better to perform gastric ESD on continuous warfarin therapy or heparin bridging therapy. We report the case of a 65-year-old Japanese man who had been diagnosed with early gastric cancer. He had a past medical history of metallic valve replacement for mitral valve regurgitation, coronary artery disease with bare metal stent, and coronary artery bypass graft. Warfarin and low dose aspirin had been used to prevent thromboembolic events in the metallic mitral valve and coronary artery stent. We performed gastric ESD safely on continuous warfarin and low dose aspirin without any complications.
-
References
- 1 Oda I, Saito D, Tada M et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006; 9: 262-267
- 2 Boustière C, Veitch A, Vanbiervliet G et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. . Endoscopy 2011; 43: 445-458
- 3 Fujimoto K, Fujishiro M, Kato M et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 2014; 26: 1-14
- 4 Anderson MA, Ben-Menachem T, Gan SI et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 2009; 70: 1060-1070
- 5 Veitch AM, Barglin TP, Gershlich AH et al. Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut 2008; 57: 1322-1329
- 6 Yoshio T, Nishida T, Kawai N et al. Gastric ESD under heparin replacement at high-risk patients of thromboembolism is technically feasible but has a high risk of delayed bleeding: Osaka University ESD Study Group. Gastroenterol Res Pract 2013; 2013: 365-830
- 7 Feng L, Li Y, Li J et al. Oral anticoagulation continuation compared with heparin bridging therapy among high risk patients undergoing implantation of cardiac rhythm devices. Thromb Haemost 2012; 108: 1124-1131
- 8 Bienie DH, Healey JS, Wells GA et al. Pacemaker or defibrillator surgery without interruption of anticoagulation. NEJM 2013; 368: 2084-2093
- 9 Lim JH, Kim SG, Kim JW et al. Do antiplatelets increase the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms?. Gastrointest Endosc 2012; 75: 719-727
- 10 Tounou S, Morita Y, Hosono T. Continuous aspirin use dose not increase post-endoscopic submucosal dissection bleeding risk for gastric neoplasms in patients on antiplatelet therapy. EIO 2015; 03: E31-E38