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

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.