Clinical impact of the perioperative management of oral anticoagulants in bleeding after colonic endoscopic mucosal resection.
Administration, Oral
Aged
Anticoagulants
/ administration & dosage
Colonic Polyps
/ surgery
Drug Administration Schedule
Endoscopic Mucosal Resection
Female
Fibrinolytic Agents
/ administration & dosage
Gastrointestinal Hemorrhage
/ epidemiology
Heparin
/ administration & dosage
Humans
Japan
/ epidemiology
Male
Middle Aged
Perioperative Care
Platelet Aggregation Inhibitors
/ administration & dosage
Retrospective Studies
Warfarin
/ administration & dosage
Colon polyp
Direct oral anticoagulant
Endoscopic mucosal resection
Heparin bridging therapy
Warfarin
Journal
BMC gastroenterology
ISSN: 1471-230X
Titre abrégé: BMC Gastroenterol
Pays: England
ID NLM: 100968547
Informations de publication
Date de publication:
02 Dec 2019
02 Dec 2019
Historique:
received:
15
07
2019
accepted:
21
11
2019
entrez:
4
12
2019
pubmed:
4
12
2019
medline:
21
4
2020
Statut:
epublish
Résumé
Heparin bridging therapy (HBT) is indeed related to a high frequency of bleeding after endoscopic mucosal resection (EMR). In this study, our aim was to investigate clinical impact of management of oral anticoagulants without HBT in bleeding after colonic EMR. From data for patients who underwent consecutive colonic EMR, the relationships of patient factors and procedural factors with the risk of bleeding were analysed. Our management of antithrombotic agents was based on the shortest cessation as follows: the administration of warfarin was generally continued within the therapeutic range, and direct oral anticoagulants (DOACs) were not administered on the day of the procedure. We calculated bleeding risks after EMR in patients who used antithrombotic agents and evaluated whether perioperative management of anticoagulants without HBT was beneficial for bleeding. A total of 1734 polyps in 825 EMRs were analysed. Bleeding occurred in 4.0% of the patients and 1.9% of the polyps. The odds ratios for bleeding using multivariate logistic regression analysis were 3.67 in patients who used anticoagulants and 4.95 in patients who used both anticoagulants and antiplatelet agents. In patients with one-day skip of DOACs, bleeding occurred in 6.5% of the polyps, and there were no significant differences in bleeding risk between HBT and continuous warfarin or one-day skip DOACs. The use of oral anticoagulants was related to bleeding after colonic EMR, and perioperative management of oral anticoagulants based on the shortest cessation without HBT would be clinically acceptable.
Sections du résumé
BACKGROUND
BACKGROUND
Heparin bridging therapy (HBT) is indeed related to a high frequency of bleeding after endoscopic mucosal resection (EMR). In this study, our aim was to investigate clinical impact of management of oral anticoagulants without HBT in bleeding after colonic EMR.
METHODS
METHODS
From data for patients who underwent consecutive colonic EMR, the relationships of patient factors and procedural factors with the risk of bleeding were analysed. Our management of antithrombotic agents was based on the shortest cessation as follows: the administration of warfarin was generally continued within the therapeutic range, and direct oral anticoagulants (DOACs) were not administered on the day of the procedure. We calculated bleeding risks after EMR in patients who used antithrombotic agents and evaluated whether perioperative management of anticoagulants without HBT was beneficial for bleeding.
RESULTS
RESULTS
A total of 1734 polyps in 825 EMRs were analysed. Bleeding occurred in 4.0% of the patients and 1.9% of the polyps. The odds ratios for bleeding using multivariate logistic regression analysis were 3.67 in patients who used anticoagulants and 4.95 in patients who used both anticoagulants and antiplatelet agents. In patients with one-day skip of DOACs, bleeding occurred in 6.5% of the polyps, and there were no significant differences in bleeding risk between HBT and continuous warfarin or one-day skip DOACs.
CONCLUSIONS
CONCLUSIONS
The use of oral anticoagulants was related to bleeding after colonic EMR, and perioperative management of oral anticoagulants based on the shortest cessation without HBT would be clinically acceptable.
Identifiants
pubmed: 31791254
doi: 10.1186/s12876-019-1124-8
pii: 10.1186/s12876-019-1124-8
pmc: PMC6889536
doi:
Substances chimiques
Anticoagulants
0
Fibrinolytic Agents
0
Platelet Aggregation Inhibitors
0
Warfarin
5Q7ZVV76EI
Heparin
9005-49-6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
206Références
World J Gastrointest Endosc. 2016 Dec 16;8(20):756-762
pubmed: 28042389
Circ J. 2014;78(3):763-6
pubmed: 24451650
J Gastroenterol. 2017 Jan;52(1):50-60
pubmed: 27085338
Gastrointest Endosc. 2013 Aug;78(2):227-39
pubmed: 23725876
Dig Endosc. 2014 Jan;26(1):1-14
pubmed: 24215155
Aliment Pharmacol Ther. 2015 Oct;42(8):949-56
pubmed: 26290157
Dig Endosc. 2016 Jul;28(5):570-6
pubmed: 27018874
Arch Intern Med. 2008 Jan 14;168(1):63-9
pubmed: 18195197
Dig Endosc. 2017 Nov;29(7):743-748
pubmed: 28370508
Gastrointest Endosc. 2016 Jan;83(1):3-16
pubmed: 26621548
Dig Endosc. 2018 Jul;30(4):433-440
pubmed: 29733468
Am J Gastroenterol. 2006 Jun;101(6):1333-41
pubmed: 16771958
J Cardiol. 2015 Mar;65(3):185-90
pubmed: 25192594
Chest. 2012 Feb;141(2 Suppl):e419S-e496S
pubmed: 22315268
Circ J. 2010 Nov;74(11):2479-500
pubmed: 20962419
Thromb Haemost. 2010 Mar;103(3):572-85
pubmed: 20135071
Gastroenterol Res Pract. 2013;2013:365830
pubmed: 23843783
Gut. 2018 Oct;67(10):1805-1812
pubmed: 28874418
Endoscopy. 2016 Apr;48(4):385-402
pubmed: 26890676
J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76
pubmed: 24685669