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Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection

AIM: To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection (ESD) and individual antithrombotic agents. METHODS: A total of 2488 gastric neoplasms in 2148 consecutive patients treated between May 2001 and June 2016 were studied. The antithr...

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Autores principales: Sato, Chiko, Hirasawa, Kingo, Koh, Ryonho, Ikeda, Ryosuke, Fukuchi, Takehide, Kobayashi, Ryosuke, Kaneko, Hiroaki, Makazu, Makomo, Maeda, Shin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558119/
https://www.ncbi.nlm.nih.gov/pubmed/28852315
http://dx.doi.org/10.3748/wjg.v23.i30.5557
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author Sato, Chiko
Hirasawa, Kingo
Koh, Ryonho
Ikeda, Ryosuke
Fukuchi, Takehide
Kobayashi, Ryosuke
Kaneko, Hiroaki
Makazu, Makomo
Maeda, Shin
author_facet Sato, Chiko
Hirasawa, Kingo
Koh, Ryonho
Ikeda, Ryosuke
Fukuchi, Takehide
Kobayashi, Ryosuke
Kaneko, Hiroaki
Makazu, Makomo
Maeda, Shin
author_sort Sato, Chiko
collection PubMed
description AIM: To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection (ESD) and individual antithrombotic agents. METHODS: A total of 2488 gastric neoplasms in 2148 consecutive patients treated between May 2001 and June 2016 were studied. The antithrombotic agents were categorized into antiplatelet agents, anticoagulants, and other antithrombotic agents, and we included combination therapies [e.g., dual antiplatelet therapy (DAPT)]. The risk factors associated with post-ESD bleeding, namely, antithrombotic agents overall, individual antithrombotic agents, withdrawal or continuation of antithrombotic agents, and bleeding onset period (during the first six days or thereafter), were analyzed using univariate and multivariate analyses. RESULTS: The en bloc resection and complete curative resection rates were 99.2% and 91.9%, respectively. Postoperative bleeding occurred in 5.1% cases. Bleeding occurred in 10.3% of the patients administered antithrombotic agents. Being male (P = 0.007), specimen size (P < 0.001), and antithrombotic agent used (P < 0.001) were independent risk factors for postoperative bleeding. Heparin bridging therapy (HBT) (P = 0.002) and DAPT/multidrug combinations (P < 0.001) were independent risk factors associated with postoperative bleeding. The bleeding rate of the antithrombotic agent continuation group was significantly higher than that of the withdrawal group (P < 0.01). Bleeding within postoperative day (POD) 6 was significantly higher in warfarin (P = 0.015), and bleeding after POD 7 was significantly higher in DAPT/multidrug combinations (P = 0.007). No thromboembolic events were reported. CONCLUSION: We must closely monitor patients administered HBT and DAPT/multidrug combinations after gastric ESD, particularly those administered multidrug combinations after discharge.
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spelling pubmed-55581192017-08-29 Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection Sato, Chiko Hirasawa, Kingo Koh, Ryonho Ikeda, Ryosuke Fukuchi, Takehide Kobayashi, Ryosuke Kaneko, Hiroaki Makazu, Makomo Maeda, Shin World J Gastroenterol Retrospective Cohort Study AIM: To investigated the relationship between postoperative bleeding following gastric endoscopic submucosal dissection (ESD) and individual antithrombotic agents. METHODS: A total of 2488 gastric neoplasms in 2148 consecutive patients treated between May 2001 and June 2016 were studied. The antithrombotic agents were categorized into antiplatelet agents, anticoagulants, and other antithrombotic agents, and we included combination therapies [e.g., dual antiplatelet therapy (DAPT)]. The risk factors associated with post-ESD bleeding, namely, antithrombotic agents overall, individual antithrombotic agents, withdrawal or continuation of antithrombotic agents, and bleeding onset period (during the first six days or thereafter), were analyzed using univariate and multivariate analyses. RESULTS: The en bloc resection and complete curative resection rates were 99.2% and 91.9%, respectively. Postoperative bleeding occurred in 5.1% cases. Bleeding occurred in 10.3% of the patients administered antithrombotic agents. Being male (P = 0.007), specimen size (P < 0.001), and antithrombotic agent used (P < 0.001) were independent risk factors for postoperative bleeding. Heparin bridging therapy (HBT) (P = 0.002) and DAPT/multidrug combinations (P < 0.001) were independent risk factors associated with postoperative bleeding. The bleeding rate of the antithrombotic agent continuation group was significantly higher than that of the withdrawal group (P < 0.01). Bleeding within postoperative day (POD) 6 was significantly higher in warfarin (P = 0.015), and bleeding after POD 7 was significantly higher in DAPT/multidrug combinations (P = 0.007). No thromboembolic events were reported. CONCLUSION: We must closely monitor patients administered HBT and DAPT/multidrug combinations after gastric ESD, particularly those administered multidrug combinations after discharge. Baishideng Publishing Group Inc 2017-08-14 2017-08-14 /pmc/articles/PMC5558119/ /pubmed/28852315 http://dx.doi.org/10.3748/wjg.v23.i30.5557 Text en ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Cohort Study
Sato, Chiko
Hirasawa, Kingo
Koh, Ryonho
Ikeda, Ryosuke
Fukuchi, Takehide
Kobayashi, Ryosuke
Kaneko, Hiroaki
Makazu, Makomo
Maeda, Shin
Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection
title Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection
title_full Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection
title_fullStr Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection
title_full_unstemmed Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection
title_short Postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection
title_sort postoperative bleeding in patients on antithrombotic therapy after gastric endoscopic submucosal dissection
topic Retrospective Cohort Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558119/
https://www.ncbi.nlm.nih.gov/pubmed/28852315
http://dx.doi.org/10.3748/wjg.v23.i30.5557
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