Rates and Risk Factors of Bleeding After Gastric Endoscopic Submucosal Dissection with Continuous Warfarin or 1-day Withdrawal of Direct Oral Anticoagulants

Overview

Journal J Gastroenterol Hepatol

Specialty Gastroenterology

Date 2024 Oct 4

PMID 39363400

Authors

Shoichiro Hirata

Kenta Hamada

Masaya Iwamuro

Hirokazu Mouri

Koji Miyahara

Takao Tsuzuki

Kenji Yamauchi

Sayo Kobayashi

Sakuma Takahashi

Ryuta Takenaka

Shinichiro Hori

Masafumi Inoue

Tatsuya Toyokawa

Mamoru Nishimura

Shuhei Ishiyama

Jiro Miyaike

Ryo Kato

Minoru Matsubara

Naoko Yunoki

Hiromitsu Kanzaki

Yoshiro Kawahara

Hiroyuki Okada

Hideki Ishikawa

Motoyuki Otsuka

Affiliations

Soon will be listed here.

Abstract

Background And Aim: The 2017 Japanese guidelines recommend continuing warfarin therapy during the perioperative period or discontinuing direct oral anticoagulants (DOACs) only on the day of endoscopic submucosal dissection for early gastric cancer. However, their safety has not been sufficiently explored. This study aimed to validate this management method.

Methods: This retrospective, multicenter study analyzed the characteristics and outcomes of patients who underwent gastric endoscopic submucosal dissection between July 2017 and June 2019. The patients were categorized according to the use of warfarin or DOACs.

Results: Among the 62 eligible patients, 53 (85%) were male (median age, 76 years). Warfarin was used in 10 patients (16%) and DOACs in 52 patients (84%). Fourteen patients taking DOACs (27%) used concomitant antiplatelet agents, with seven patients (13%) continuing treatment at the time of the endoscopic procedure. No postprocedural bleeding occurred in patients receiving warfarin (0%), whereas 10 cases (19%) of bleeding occurred in patients receiving DOACs: rivaroxaban, 0% (0/22); dabigatran, 0% (0/2); edoxaban, 43% (6/14); and apixaban, 29% (4/14). The type of anticoagulant (P < 0.01) and continuation of antiplatelet therapy (P = 0.02) were risk factors for postprocedural bleeding in patients receiving DOACs. Intraprocedural bleeding requiring transfusion or symptomatic thromboembolic events were not reported.

Conclusions: Continuous warfarin therapy is preferred. DOAC withdrawal 1 day before a procedure is associated with a high bleeding rate, which may differ for different types of anticoagulants. The continuation of antiplatelet medications in patients receiving DOACs carries a high risk of bleeding and is a future challenge.

Citing Articles

Rates and risk factors of bleeding after gastric endoscopic submucosal dissection with continuous warfarin or 1-day withdrawal of direct oral anticoagulants.

Hirata S, Hamada K, Iwamuro M, Mouri H, Miyahara K, Tsuzuki T J Gastroenterol Hepatol. 2024; 39(12):2760-2766.

PMID: 39363400 PMC: 11660194. DOI: 10.1111/jgh.16757.

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