Journal Basic Info
- Impact Factor: 1.995**
- H-Index: 8
- ISSN: 2474-1647
- DOI: 10.25107/2474-1647
Major Scope
- Orthopaedic Surgery
- Plastic Surgery
- Breast Surgery
- Pediatric Surgery
- Emergency Surgery
- Vascular Surgery
- Otolaryngology - Head and Neck Surgery
- Endocrine Surgery
Abstract
Citation: Clin Surg. 2018;3(1):2102.Research Article | Open Access
Postoperative Bleeding after Gastric Endoscopic Submucosal Dissection in Patients on Anticoagulant Therapy, Especially Warfarin and DOAC
Tsukasa Furuhata, Shu Hoteya, Toshiro Iizuka, Akihiro Yamada, Kosuke Nomura, Yasutaka Kuribayashi, Daisuke Kikuchi, Akira Matsui, Satoshi Yamashta and Toshifumi Mitani
Departments of Gastroenterology, Toranomon Hospital, Japan
*Correspondance to: Tsukasa Furuhata
PDF Full Text DOI: 10.25107/2474-1647.2102
Abstract
Background and Aims: It is controversial whether anticoagulant therapy increases the risk of bleeding after Endoscopic Submucosal Dissection (ESD). The aim of this study is to evaluate the effects of anticoagulant therapy on gastric ESD.Methods: Patients who underwent gastric ESD in Toranomon Hospital between April 2005 and July 2017 were enrolled. The risk of post-ESD bleeding was evaluated using multivariate cox proportional hazards analysis.Results: Of 1979 patients enrolled, 49 were taking anticoagulant agent; 25 discontinued warfarin and switched to heparin alternative therapy during ESD, whereas 24 discontinued DOAC (Direct oral anticoagulant). During 2 months of the entire observational period, post-ESD bleeding occurred in 88 patients (4.4%): 80 patients without any anticoagulant agent (4.1%), 8 patients with anticoagulant agent (9.1%); 4 patients with a warfarin (16.0%), 4patients with DOAC (16.7%). In multivariate analysis, anticoagulant therapy [hazards ratio (HR) 6.24, 95% confidence interval (CI): 2.93–13.27], warfarin (HR4.19, 95% CI: 2.10–16.62), DOAC (HR6.71, 95% CI: 2.39-18.82) were independent risk factors of post-ESD bleeding.Conclusion: Because anticoagulant therapy significantly increases the risk of post-ESD bleeding, it should be necessary to strictly management at least two weeks after ESD.
Keywords
ESD, Anticoagulant, DOAC, Warfarin, Gastric tumor
Cite the article
Furuhata T, Hoteya S, Iizuka T, Yamada A, Nomura K, Kuribayashi Y, et al. Postoperative Bleeding after Gastric Endoscopic Submucosal Dissection in Patients on Anticoagulant Therapy, Especially Warfarin and DOAC. Clin Surg. 2018; 3: 2102.
