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Gastric Cancer
Published in: Gastric Cancer 1/2021

01-01-2021 | Dabigatran | Original Article

Influence of anticoagulants on the risk of delayed bleeding after gastric endoscopic submucosal dissection: a multicenter retrospective study

Authors: Hideomi Tomida, Toshiyuki Yoshio, Kimihiro Igarashi, Yoshinori Morita, Ichiro Oda, Takuya Inoue, Takuto Hikichi, Tetsuya Sumiyoshi, Hisashi Doyama, Yosuke Tsuji, Jun Nishikawa, Waku Hatta, Tatsuya Mikami, Mikitaka Iguchi, Kazuki Sumiyama, Katsumi Yamamoto, Kazuya Kitamura, Shiko Kuribayashi, Atsushi Yanagitani, Toshio Uraoka, Tomoyuki Yada, Kenkei Hasatani, Koichiro Kawaguchi, Tomoki Fujita, Tsutomu Nishida, Yoichi Hiasa, Mitsuhiro Fujishiro, for the FIGHT-Japan Study Group

Published in: Gastric Cancer | Issue 1/2021

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Abstract

Background and aims

Delayed bleeding after gastric endoscopic submucosal dissection (ESD) in patients receiving anticoagulants remains an unpreventable adverse event. Although direct-acting oral anticoagulants (DOACs) have superior efficacy in preventing thromboembolism, their effects on the occurrence of delayed bleeding remain unclear. This study aimed to elucidate the clinical effect of DOACs on delayed bleeding after gastric ESD.

Patients and methods

We retrospectively examined 728 patients who received anticoagulants and were treated for gastric neoplasms with ESD in 25 institutions across Japan. Overall, 261 patients received DOACs, including dabigatran (92), rivaroxaban (103), apixaban (45) and edoxaban (21), whereas 467 patients were treated with warfarin.

Results

Delayed bleeding occurred in 14% of patients taking DOACs, which was not considerably different in patients receiving warfarin (18%). Delayed bleeding rate was significantly lower in patients receiving dabigatran than in those receiving warfarin and lower than that observed for other DOACs. Multivariate analysis showed that age ≥ 65, receiving multiple antithrombotic agents, resection of multiple lesions and lesion size ≥ 30 mm were independent risk factors, and that discontinuation of anticoagulants was associated with a decreased risk of bleeding. In multivariate analysis among patients taking DOACs, dabigatran therapy was associated with a significantly lower risk of delayed bleeding.

Conclusions

The effects of DOACs on delayed bleeding varied between agents, but dabigatran therapy was associated with the lowest risk of delayed bleeding. Switching oral anticoagulants to dabigatran during the perioperative period could be a reasonable option to reduce the risk of delayed bleeding after gastric ESD.
Appendix
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Metadata
Title
Influence of anticoagulants on the risk of delayed bleeding after gastric endoscopic submucosal dissection: a multicenter retrospective study
Authors
Hideomi Tomida
Toshiyuki Yoshio
Kimihiro Igarashi
Yoshinori Morita
Ichiro Oda
Takuya Inoue
Takuto Hikichi
Tetsuya Sumiyoshi
Hisashi Doyama
Yosuke Tsuji
Jun Nishikawa
Waku Hatta
Tatsuya Mikami
Mikitaka Iguchi
Kazuki Sumiyama
Katsumi Yamamoto
Kazuya Kitamura
Shiko Kuribayashi
Atsushi Yanagitani
Toshio Uraoka
Tomoyuki Yada
Kenkei Hasatani
Koichiro Kawaguchi
Tomoki Fujita
Tsutomu Nishida
Yoichi Hiasa
Mitsuhiro Fujishiro
for the FIGHT-Japan Study Group
Publication date
01-01-2021
Publisher
Springer Singapore
Published in
Gastric Cancer / Issue 1/2021
Print ISSN: 1436-3291
Electronic ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-020-01105-0

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