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01-08-2020 | Dabigatran

The effect of anticoagulants on delayed bleeding after colorectal endoscopic submucosal dissection

Authors: Hideaki Harada, Ryotaro Nakahara, Daisuke Murakami, Satoshi Suehiro, Takuya Nagasaka, Tetsuro Ujihara, Ryota Sagami, Yasushi Katsuyama, Kenji Hayasaka, Shigetaka Tounou, Yuji Amano

Published in: Surgical Endoscopy | Issue 8/2020

Abstract

Background and aims

The withdrawal of antithrombotic therapy from patients at high risk of thromboembolism is controversial. Previously, treatment with anticoagulants, such as warfarin and dabigatran, was recommended for heparin bridge therapy (HBT) during endoscopic submucosal dissection (ESD). However, HBT is associated with a high risk of bleeding during and after ESD. This study aimed to investigate the clinical outcomes of colorectal ESD in patients treated with warfarin and direct oral anticoagulants (DOAC).

Methods

This study included 412 patients with superficial colorectal neoplasms that were resected by ESD between June 2010 and June 2018. The patients were classified into two groups: without antithrombotics (n = 286) and with anticoagulants (n = 51). The anticoagulants group was further divided into two groups: warfarin (n = 26) and DOAC (n = 25).

Results

Among all patients, delayed bleeding occurred in 35 (8.5% [35/412]) patients. The bleeding rate in the anticoagulants group (11.8% [6/51]) was higher than that in the group without antithrombotics (6.6% [19/286]), but the difference was not statistically significant (P = 0.240). The bleeding rate in the DOAC group (16.0% [4/25]) was higher than that in the warfarin group (7.7% [2/26]), but the difference was not statistically significant (P = 0.419). All delayed bleeding was successfully managed with endoscopic hemostasis. Thromboembolic events were not observed in any patients.

Conclusions

The bleeding rate with anticoagulants was relatively high. However, all bleeding events with anticoagulants were minor and clinically controllable. Colorectal ESD with DOAC and warfarin may be feasible and acceptable.

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Title: The effect of anticoagulants on delayed bleeding after colorectal endoscopic submucosal dissection
Authors: Hideaki Harada
Ryotaro Nakahara
Daisuke Murakami
Satoshi Suehiro
Takuya Nagasaka
Tetsuro Ujihara
Ryota Sagami
Yasushi Katsuyama
Kenji Hayasaka
Shigetaka Tounou
Yuji Amano
Publication date: 01-08-2020
Publisher: Springer US
Keywords: Dabigatran
Anticoagulant
Direct Oral Anticoagulant
Apixaban
Warfarin
Direct Oral Anticoagulant
Published in: Surgical Endoscopy / Issue 8/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-07101-5

2024 ASCO Annual Meeting

Springer Medicine

The effect of anticoagulants on delayed bleeding after colorectal endoscopic submucosal dissection

Abstract

Background and aims

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background and aims

Methods

Results

Conclusions

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