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Hokkaido University Collection of Scholarly and Academic Papers >
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Bleeding After Gastric Endoscopic Submucosal Dissection Focused on Management of Xa Inhibitors
| Title: | Bleeding After Gastric Endoscopic Submucosal Dissection Focused on Management of Xa Inhibitors |
| Authors: | Ono, Shoko Browse this author →KAKEN DB | | Ieko, Masahiro Browse this author | | Tanaka, Ikko Browse this author | | Shimoda, Yoshihiko Browse this author | | Ono, Masayoshi Browse this author →KAKEN DB | | Yamamoto, Keiko Browse this author →KAKEN DB | | Sakamoto, Naoya Browse this author →KAKEN DB |
| Keywords: | Gastric cancer | | Endoscopic submucosal dissection | | Factor Xa inhibitor | | Hemorrhage |
| Issue Date: | 23-Feb-2022 |
| Publisher: | Korean Gastric Cancer Association |
| Journal Title: | Journal of Gastric Cancer |
| Volume: | 22 |
| Issue: | 1 |
| Start Page: | 47 |
| End Page: | 55 |
| Publisher DOI: | 10.5230/jgc.2022.22.e2 |
| Abstract: | Purpose: The use of direct oral Xa inhibitors (DXaIs) to prevent venothrombotic events is increasing. However, gastrointestinal bleeding, including that related to endoscopic resection, is a concern. In this study, we evaluated bleeding and coagulation times during the perioperative period of gastric endoscopic submucosal dissection (ESD). Materials and Methods: Patients who consecutively underwent gastric ESD from August 2016 to December 2018 were analyzed. Bleeding rates were compared among the 3 groups (antiplatelet, DXaIs, and control). DXaI administration was discontinued on the day of the procedure. Prothrombin time (PT), activated partial thromboplastin time, and the ratio of inhibited thrombin generation (RITG), which was based on dilute PT, were determined before and after ESD. Results: During the study period, 265 gastric ESDs were performed in 239 patients, where 23 and 50 patients received DXaIs and antiplatelets, respectively. Delayed bleeding occurred in 17 patients (7.4%) and 21 lesions (7.1%). The bleeding rate in the DXaI group was significantly higher than that in the other groups (30.4%, P<0.01), and the adjusted odds ratio of bleeding was 5.7 (95% confidence interval, 1.4-23.7; P=0.016). In patients using DXaIs, there was a significant (P=0.046) difference in the median RITG between bleeding cases (18.6%) and non-bleeding cases (3.8%). Conclusions: A one-day cessation of DXaIs was related to a high incidence of bleeding after gastric ESD, and monitoring of residual coagulation activity at trough levels might enable the predicted risk of delayed bleeding in patients using DXaIs. |
| Type: | article |
| URI: | http://hdl.handle.net/2115/85518 |
| Appears in Collections: | 医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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