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CC BY-NC-ND 4.0 · Endosc Int Open 2017; 05(05): E348-E353
DOI: 10.1055/s-0043-105493
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2017

Continuous use of low-dose warfarin for gastric endoscopic submucosal dissection: a prospective study

Hideaki Harada
1   Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
,
Satoshi Suehiro
1   Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
,
Daisuke Murakami
1   Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
,
Takanori Shimizu
1   Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
,
Ryotaro Nakahara
1   Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
,
Yasushi Katsuyama
1   Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
,
Yasunaga Miyama
2   Department of Health Service Center, Tokyo Medical and Dental University, Tokyo, Japan
,
Shigetaka Tounou
3   Second Division of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
,
Kenji Hayasaka
1   Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
› Author Affiliations
Further Information

Publication History

submitted 04 August 2016

accepted after revision 06 February 2017

Publication Date:
05 May 2017 (online)

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Abstract

Background and study aims Patients who receive warfarin usually require heparin bridge therapy (HBT) to prevent thromboembolic events during endoscopic submucosal dissection (ESD); however, clinical evidence demonstrating the safety and efficacy of HBT during gastric ESD is limited. Conversely, warfarin can be continuously used as a substitute for HBT to endoscopic procedures which have a low risk of bleeding. This study aimed to clarify the safety and efficacy of continuous low-dose warfarin (LDW) for gastric ESD.

Patients and methods This was a prospective observational study at a single institution. A total of 22 patients who received warfarin between December 2014 and January 2016 were enrolled. The patients were treated with gastric ESD with a low dose of warfarin ( ≤ 4 mg) at approximately 1.6 – 2.6 of the international normalized ratio (INR) levels. Furthermore, we analyzed a total of 23 patients with HBT who underwent gastric ESD between January 2011 and November 2014.

Results The average of warfarin dose and the INR level on the day of gastric ESD in the continuous LDW group were 2.3 mg/day (range 0.5 – 4.0) and 1.87 (range 1.41 – 2.75), respectively. Two of the 22 patients (9.1 %) in the continuous LDW group and 5 of the 23 patients (21.7 %) in the HBT group had postoperative bleeding after gastric ESD. Although the postoperative bleeding rate in the continuous LDW group was lower than that in the HBT group, no significant difference was observed between the 2 groups (P = 0.414).

Conclusions Gastric ESD with continuous LDW as a substitute for HBT was feasible and may be acceptable.

 

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