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Related Experiment Video

Updated: May 29, 2025

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Bleeding Risk During Colorectal Endoscopic Mucosal Resection With Continued Anticoagulant Therapy: A Multicenter

Sayo Kobayashi1, Keita Harada2,3, Toru Nawa1

  • 1Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, JPN.

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|February 3, 2025
PubMed
Summary

Continuing oral anticoagulants during endoscopic mucosal resection (EMR) for colorectal cancer is safe, with a low major bleeding rate of 4.7%. This approach is a viable alternative to heparin bridging, minimizing both bleeding and thrombotic risks.

Keywords:
anticoagulant therapydirect oral anticoagulantendoscopic mucosal dissectionendoscopic mucosal resectionthrombosiswarfarin

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Area of Science:

  • Gastroenterology
  • Oncology
  • Cardiology

Background:

  • Endoscopic mucosal resection (EMR) is crucial for colorectal cancer prevention.
  • Managing patients on anticoagulants during EMR presents a challenge due to bleeding and thrombotic risks.
  • Current guidelines favor continuing anticoagulants over heparin bridging, but bleeding data is limited.

Purpose of the Study:

  • To evaluate the bleeding rates in patients undergoing EMR while continuing oral anticoagulants.
  • To compare bleeding risks between warfarin and direct oral anticoagulants (DOACs).
  • To assess the safety of continuing anticoagulation as an alternative to heparin bridging.

Main Methods:

  • A multicenter prospective study enrolled 107 patients undergoing EMR across 12 tertiary hospitals.
  • Patients continued warfarin or temporarily paused direct oral anticoagulants (DOACs) on the day of EMR.
  • Major bleeding was defined as bleeding requiring difficult hemostasis or endoscopic intervention; adverse events were monitored for 30 days.

Main Results:

  • Major bleeding occurred in 4.7% of patients, with all cases managed endoscopically.
  • Minor bleeding and thromboembolism events occurred in 7.5% and 0.9% of patients, respectively.
  • No significant difference in bleeding rates was observed between warfarin and DOACs.

Conclusions:

  • Continuing oral anticoagulants during EMR is associated with a low major bleeding rate (4.7%).
  • This strategy demonstrates a favorable safety profile compared to heparin bridging.
  • The findings support continuing anticoagulation as a safe alternative for patients undergoing EMR.