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

Aged Aged, 80 and over Anticoagulants / adverse effects Dabigatran / adverse effects Endoscopic Mucosal Resection / adverse effects Female Humans Japan Male Middle Aged Postoperative Complications / prevention & control Postoperative Hemorrhage / chemically induced Pyrazoles / adverse effects Pyridines / adverse effects Pyridones / adverse effects Retrospective Studies Rivaroxaban / adverse effects Stomach / surgery Stomach Neoplasms / surgery Thiazoles / adverse effects Thromboembolism / prevention & control Warfarin / adverse effects
Dabigatran Delayed bleeding Direct-acting oral anticoagulants Gastric endoscopic submucosal dissection

Journal

Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
ISSN: 1436-3305
Titre abrégé: Gastric Cancer
Pays: Japan
ID NLM: 100886238

Informations de publication

Date de publication:
Jan 2021
Historique:
received: 03 06 2020
accepted: 09 07 2020
pubmed: 20 7 2020
medline: 11 11 2021
entrez: 20 7 2020
Statut: ppublish

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
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 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 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 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.

Identifiants

DOI: 10.1007/s10120-020-01105-0 PMID: 32683602
pubmed: 32683602
doi: 10.1007/s10120-020-01105-0
pii: 10.1007/s10120-020-01105-0
doi:

Substances chimiques

Anticoagulants 0
Pyrazoles 0
Pyridines 0
Pyridones 0
Thiazoles 0
apixaban 3Z9Y7UWC1J
Warfarin 5Q7ZVV76EI
Rivaroxaban 9NDF7JZ4M3
Dabigatran I0VM4M70GC
edoxaban NDU3J18APO

Types de publication

Evaluation Study Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

179-189

Références

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Auteurs

Hideomi Tomida (H)

Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, 7910295, Japan.
Gastroenterology Center, Ehime Prefectural Central Hospital, Kasugamachi 83, Matsuyama, 7900024, Japan.

Toshiyuki Yoshio (T)

Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 1358550, Japan. toshiyuki.yoshio@jfcr.or.jp.
ORCID: 0000-0002-6546-0329

Kimihiro Igarashi (K)

Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 4118777, Japan.

Yoshinori Morita (Y)

Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 6500017, Japan.

Ichiro Oda (I)

Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.

Takuya Inoue (T)

Division of Gastroenterology and Hepatology, Osaka General Medical Center, 3-1-56 Bandai-higashi, Sumiyoshi-ku, Osaka, 5588558, Japan.

Takuto Hikichi (T)

Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 9601295, Japan.

Tetsuya Sumiyoshi (T)

Department of Gastroenterology, Tonan Hospital, 3-8 Kita4-Nishi7, Chuo-ku, Sapporo, 0600004, Japan.

Hisashi Doyama (H)

Department of Gastroenterology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi, Kanazawa, 9208530, Japan.

Yosuke Tsuji (Y)

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655, Japan.

Jun Nishikawa (J)

Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, 7558505, Japan.

Waku Hatta (W)

Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 9808574, Japan.

Tatsuya Mikami (T)

Division of Endoscopy, Hirosaki University Hospital, 53 Honcho, Hirosaki, 0368563, Japan.

Mikitaka Iguchi (M)

Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 6410012, Japan.

Kazuki Sumiyama (K)

Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 1058461, Japan.

Katsumi Yamamoto (K)

Department of Gastroenterology, JCHO Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka, 5530003, Japan.

Kazuya Kitamura (K)

Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 9208641, Japan.

Shiko Kuribayashi (S)

Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, 3718511, Japan.

Atsushi Yanagitani (A)

Department of Gastroenterology, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, 6800901, Japan.

Toshio Uraoka (T)

Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 1528902, Japan.

Tomoyuki Yada (T)

Division of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, 2728516, Japan.

Kenkei Hasatani (K)

Department of Gastroenterology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, 9108526, Japan.

Koichiro Kawaguchi (K)

Department of Gastroenterology, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, 6838504, Japan.

Tomoki Fujita (T)

Department of Gastroenterology, Otaru Ekisaikai Hospital, 1-4-1 Inaho, Otaru, 0470032, Japan.

Tsutomu Nishida (T)

Department of Gastroenterology, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, 5608565, Japan.

Yoichi Hiasa (Y)

Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, 7910295, Japan.

Mitsuhiro Fujishiro (M)

Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Influence of anticoagulants on the risk of...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Influence of anticoagulants on the risk of...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Influence of anticoagulants on the risk of...
questionsmedicales.fr › Composés hétérocycliques › Composés hétérocycliques à cycles fusionnés › Composés hétérobicycliques › Benzimidazoles › Dabigatran › Influence of anticoagulants on the risk of...
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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Hémorragie postopératoire › Influence of anticoagulants on the risk of...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Azoles › Pyrazoles › Influence of anticoagulants on the risk of...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Pyridines › Influence of anticoagulants on the risk of...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Pyridines › Pyridones › Influence of anticoagulants on the risk of...
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