Optimal Timing of Resuming Anticoagulant After Colorectal Endoscopic Submucosal Dissection

Area of Science:

• Gastroenterology
• Endoscopy
• Cardiology

Background:

• Delayed bleeding is a significant risk after colorectal endoscopic submucosal dissection (ESD), especially for patients on anticoagulants.
• Optimal timing for resuming anticoagulant therapy post-ESD remains unclear, posing a clinical challenge.

Purpose of the Study:

• To determine the optimal timing for resuming anticoagulant therapy after colorectal ESD.
• To evaluate the safety of early versus late anticoagulant resumption in patients undergoing colorectal ESD.

Main Methods:

• Retrospective analysis of 1309 colorectal ESD cases from the ABCD-J study (34,450 total cases).
• Patients were categorized into early (resumption within 1 day) and late (resumption ≥2 days) anticoagulant groups.
• Propensity score matching was used to compare delayed bleeding, perforation, and thromboembolic events between groups.

Main Results:

• No significant difference in overall delayed bleeding rates between early and late resumption groups (9.6% vs. 6.6%).
• Early resumption showed a lower bleeding rate before resumption (1.18% vs. 3.23%) but higher after (9.42% vs. 6.02%).
• No significant difference in thromboembolic events or delayed bleeding in subgroup analyses for direct oral anticoagulants (DOACs) or warfarin.

Conclusions:

• Early resumption of anticoagulants within 1 day post-ESD is safe.
• Early anticoagulant resumption does not significantly increase the risk of delayed bleeding after colorectal ESD.