Low-Dose Aspirin Continuation During Gastric Endoscopic Submucosal Dissection in Patients With Low Thrombotic Risk: A...

Area of Science:

• Gastroenterology
• Oncology
• Cardiology

Background:

• Low-dose aspirin (LDA) use is common for cardiovascular prevention.
• Discontinuation of LDA during periprocedural period of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is debated.
• The safety of continuing LDA during gastric ESD in low thrombotic risk patients needs clarification.

Purpose of the Study:

• To evaluate if continuing LDA is non-inferior to discontinuing it regarding ESD-related major bleeding risk.
• To assess the safety of sustained antiplatelet effects during gastric ESD in patients with low thrombotic risk.

Main Methods:

• A randomized controlled trial was conducted with patients undergoing gastric ESD for mucosal neoplasms and low thrombotic risk on LDA.
• Participants were assigned to either LDA discontinuation or continuation groups.
• The primary endpoint was the incidence of ESD-related major bleeding.

Main Results:

• The incidence of major bleeding was 7.6% in the discontinuation group and 10% in the continuation group.
• LDA continuation was not found to be non-inferior to discontinuation, as the upper limit of the 90% confidence interval exceeded the non-inferiority margin.
• Two patients in the continuation group experienced cerebral infarction.

Conclusions:

• Continuation of LDA during gastric ESD in low thrombotic risk patients did not demonstrate non-inferiority for bleeding risk compared to discontinuation.
• Discontinuation of LDA is recommended during the periprocedural period for gastric ESD in this patient group.
• Further research may be needed to explore alternative antiplatelet strategies.