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Bleeding After Gastric Endoscopic Submucosal Dissection Focused on Management of Xa Inhibitors

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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
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
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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