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Clinical impact of the perioperative management of oral anticoagulants in bleeding after colonic endoscopic mucosal resection

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Title: Clinical impact of the perioperative management of oral anticoagulants in bleeding after colonic endoscopic mucosal resection
Authors: Ono, Shoko Browse this author →KAKEN DB
Ishikawa, Marin Browse this author
Matsuda, Kana Browse this author
Tsuda, Momoko Browse this author
Yamamoto, Keiko Browse this author →KAKEN DB
Shimizu, Yuichi Browse this author →KAKEN DB
Sakamoto, Naoya Browse this author →KAKEN DB
Keywords: Warfarin
Direct oral anticoagulant
Heparin bridging therapy
Endoscopic mucosal resection
Colon polyp
Issue Date: 2-Dec-2019
Publisher: BioMed Central
Journal Title: BMC gastroenterology
Volume: 19
Issue: 1
Start Page: 206
Publisher DOI: 10.1186/s12876-019-1124-8
PMID: 31791254
Abstract: Background Heparin bridging therapy (HBT) is indeed related to a high frequency of bleeding after endoscopic mucosal resection (EMR). In this study, our aim was to investigate clinical impact of management of oral anticoagulants without HBT in bleeding after colonic EMR. Methods From data for patients who underwent consecutive colonic EMR, the relationships of patient factors and procedural factors with the risk of bleeding were analysed. Our management of antithrombotic agents was based on the shortest cessation as follows: the administration of warfarin was generally continued within the therapeutic range, and direct oral anticoagulants (DOACs) were not administered on the day of the procedure. We calculated bleeding risks after EMR in patients who used antithrombotic agents and evaluated whether perioperative management of anticoagulants without HBT was beneficial for bleeding. Results A total of 1734 polyps in 825 EMRs were analysed. Bleeding occurred in 4.0% of the patients and 1.9% of the polyps. The odds ratios for bleeding using multivariate logistic regression analysis were 3.67 in patients who used anticoagulants and 4.95 in patients who used both anticoagulants and antiplatelet agents. In patients with one-day skip of DOACs, bleeding occurred in 6.5% of the polyps, and there were no significant differences in bleeding risk between HBT and continuous warfarin or one-day skip DOACs. Conclusions The use of oral anticoagulants was related to bleeding after colonic EMR, and perioperative management of oral anticoagulants based on the shortest cessation without HBT would be clinically acceptable.
Type: article
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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