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Effect of Continued Administration of Low-dose Aspirin for Intraoperative Bleeding Control in Gastric Endoscopic

Yohei Horikawa1, Hiroya Mizutamari2, Nobuya Mimori2

  • 1Department of Gastroenterology, Hiraka General Hospital, Yokote, Japan, horikawa_01@me.com.

Digestion
|December 5, 2018
PubMed

Insights

Low-dose aspirin (LDA) can be safely continued during gastric endoscopic submucosal dissection (ESD). This study found no significant increase in intraoperative bleeding when LDA was not stopped before the procedure.

Area of Science:

  • Gastroenterology
  • Endoscopy
  • Oncology

Background:

  • Antithrombotic agents are increasingly used for cerebro-cardioembolic event prevention.
  • Guidelines suggest continuing low-dose aspirin (LDA) during high-bleeding-risk endoscopic procedures.
  • The impact of LDA on intraoperative bleeding during Endoscopic submucosal dissection (ESD) is not well understood.

Purpose of the Study:

  • To evaluate the safety and influence of continuing low-dose aspirin (LDA) on intraoperative bleeding control during gastric Endoscopic submucosal dissection (ESD).

Main Methods:

  • A comparative study of 293 gastric cancer patients undergoing ESD.
  • 52 patients on LDA were propensity-score matched (PSM) with 241 patients not on antithrombotics.
  • Outcomes including intraoperative bleeding, procedure time, and resection success were analyzed.

Main Results:

  • PSM analysis of 50 pairs showed similar intraoperative major bleeding rates between LDA and control groups (1 vs. 0 instances).
  • Procedure time, hemoglobin decrease, en bloc resection, and complete resection rates were comparable.
  • Postoperative bleeding occurred in 1.9% of the LDA group; no perforations or thromboembolisms were observed.

Conclusions:

  • Gastric ESD can be performed safely without discontinuing low-dose aspirin (LDA).
  • Continuing LDA does not appear to significantly increase intraoperative bleeding risk during gastric ESD.
Abstract

Keywords:
Bleeding controlEndoscopic submucosal dissectionGastric cancerLow-dose aspirin

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