Heparin-Bridging Therapy and Risk of Bleeding After Endoscopic Submucosal Dissection for Gastric Neoplasms: a...

Area of Science:

• Gastroenterology
• Cardiology
• Oncology

Background:

• Peri-procedural heparin bridging is standard for high-risk patients needing anticoagulation interruption for endoscopic submucosal dissection (ESD).
• The bleeding risk associated with heparin bridging itself in this context remains under-researched.

Purpose of the Study:

• To evaluate the bleeding risk of heparin bridging therapy in patients undergoing ESD for gastric neoplasms.
• To compare post-procedural bleeding rates between patients receiving heparin bridging and those discontinuing anticoagulation without bridging.

Main Methods:

• A systematic literature search of MEDLINE and EMBASE databases was conducted up to August 2017.
• Four studies involving 350 patients were included in a meta-analysis.
• Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effect model.

Main Results:

• Heparin bridging therapy was associated with a significantly increased risk of post-ESD bleeding.
• The pooled risk ratio for bleeding in bridged patients was 2.99 (95% CI, 1.51 to 5.92).
• No significant statistical heterogeneity was observed between the studies (I² = 0%).

Conclusions:

• Heparin bridging therapy significantly elevates the risk of bleeding after ESD for gastric neoplasms.
• The findings suggest a need to carefully weigh the benefits against the increased bleeding risks of heparin bridging in this patient population.