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Risk factors for postgastric endoscopic submucosal dissection bleeding in direct oral anticoagulant users
Tomo Kagawa1, Shigenao Ishikawa1, Yu Hidaka2
1Department of Gastroenterology, Kagawa Prefectural Central Hospital, Kagawa, Japan.
Summary
Direct oral anticoagulants (DOACs) increase bleeding risk after gastric endoscopic submucosal dissection (ESD). Dabigatran showed comparatively less bleeding risk than other DOACs, with neutrophil infiltration also a key risk factor.
Area of Science:
- Gastroenterology
- Oncology
- Pharmacology
Background:
- Endoscopic submucosal dissection (ESD) is a curative treatment for gastric tumors.
- Bleeding after ESD in patients on antithrombotic drugs, especially direct oral anticoagulants (DOACs), is a significant concern.
- Risk factors and drug-specific differences in post-ESD bleeding require further investigation.
Purpose of the Study:
- To evaluate risk factors for post-ESD bleeding in patients taking antithrombotic drugs.
- To compare bleeding risks associated with different types of DOACs after gastric ESD.
Main Methods:
- A retrospective study of 278 patients undergoing gastric ESD between January 2017 and March 2022.
- Antithrombotic drug withdrawal followed 2017 guidelines.
- Multivariate analysis assessed bleeding risk factors, including pathological evaluation of peri-cancerous mucosa.
Main Results:
- DOACs were associated with a higher risk of post-ESD bleeding (OR 4.92).
- Risk factors for bleeding in DOAC users included large resection diameter (≥30 mm), neutrophil infiltration, lower gastric lesions, and preoperative antiplatelet use.
- Bleeding rates varied by DOAC type: apixaban (25.0%), edoxaban (20.0%), rivaroxaban (21.4%), and dabigatran (0%).
Conclusions:
- DOAC administration is a risk factor for post-ESD bleeding.
- Neutrophil infiltration is a significant risk factor in DOAC users.
- Dabigatran appears to be associated with a lower risk of bleeding after gastric ESD compared to other DOACs.
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