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Should antithrombotic therapy be stopped in patients undergoing gastric endoscopic submucosal dissection?

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Abstract

Background

The management of antithrombotic therapy in the patients undergoing gastric endoscopic submucosal dissection (ESD) is of concern. This study aimed to assess delayed bleeding rate after gastric ESD in the patients receiving antithrombotic therapy.

Methods

This study was a retrospective observational study held in a single institute. The patients undergoing gastric ESD from January 2009 to October 2014 were reviewed. Delayed bleeding rate in the patients receiving antithrombotic therapy was compared with that in matched controls. We also compared delayed bleeding rate in the patients continuing antithrombotic therapy with that in the patients with heparin bridging or cessation of antithrombotic therapy. Among 2388 lesions resected by gastric ESD, 367 lesions were resected in the patients with antithrombotic therapy, and 722 lesions were selected as controls. The lesions in the patients receiving antithrombotic therapy were divided into three subgroups: 54 lesions without preoperative cessation (continuation group), 37 lesions with heparin bridging (heparin group), and 276 lesions with cessation of antithrombotic therapy (cessation group).

Results

The incidence of delayed bleeding was significantly higher in the patients receiving antithrombotic therapy (9.5 % [35/367] vs. 4.2 % [30/722]; p < 0.01). Delayed bleeding rate in continuation group, heparin group, and cessation group was 9.2 % (5/54), 10.8 % (4/37), and 9.4 % (26/276), respectively, and no significant difference was observed. Thrombosis occurred only in cessation group (1.6 %).

Conclusions

Delayed bleeding rate associated with gastric ESD is significantly higher in the patients receiving antithrombotic therapy. No significant difference in delayed bleeding rate was observed among patients with and without cessation of antithrombotic therapy. To prevent thrombosis, gastric ESD without cessation may be feasible.

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Acknowledgments

We wish to thank all the staff members in our institute for general help.

Author’s contribution

Kimihiro Igarashi was responsible for the data analysis and making a draft. Kohei Takizawa took responsibility for interpretation of the results and was involved with drafting this manuscript. Naomi Kakushima, Masaki Tanaka, Noboru Kawata, Masao Yoshida, Kinichi Hotta, Kenichiro Imai, Sayo Ito, Hirotoshi Ishiwatari, Hiroyuki Matsubayasi and Hiroyuki Ono made all important revisions to the manuscript. All of the authors read and agreed with submission of this manuscript.

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Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan

    Kimihiro Igarashi, Kohei Takizawa, Naomi Kakushima, Masaki Tanaka, Noboru Kawata, Masao Yoshida, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi & Hiroyuki Ono

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  1. Kimihiro Igarashi
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  2. Kohei Takizawa
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  3. Naomi Kakushima
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Correspondence to Kohei Takizawa.

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Kimihiro Igarashi, Kohei Takizawa, Naomi Kakushima, Masaki Tanaka, Noboru Kawata, Masao Yoshida, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayash and Hiroyuki Ono have no conflict of interest or financial ties to disclose.

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Igarashi, K., Takizawa, K., Kakushima, N. et al. Should antithrombotic therapy be stopped in patients undergoing gastric endoscopic submucosal dissection?. Surg Endosc 31, 1746–1753 (2017). https://doi.org/10.1007/s00464-016-5167-4

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  • DOI: https://doi.org/10.1007/s00464-016-5167-4

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