The postoperative bleeding rate and its risk factors in patients on antithrombotic therapy who undergo gastric endoscopic submucosal dissectionReportar como inadecuado

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BMC Gastroenterology

, 13:136

Gastroesophageal disorders


BackgroundThere is a lack of consensus regarding the risk of postoperative hemorrhage in patients on antithrombotic therapy who undergo endoscopic submucosal dissection ESD.

We examined postoperative bleeding rates and risk factors for postoperative hemorrhage from post-ESD gastric ulcers in patients on antithrombotic therapy.

MethodsThe subjects of this study were 833 patients who underwent ESD of gastric tumors. Of these, 743 were not on antithrombotic therapy and 90 were on some form of antithrombotic therapy 46 on low-dose aspirin LDA only, 23 on LDA + thienopyridine, and 21 on LDA + warfarin. All patients commenced proton pump inhibitor PPI therapy immediately postoperatively. Antiplatelet agents were discontinued for 7 days preoperatively and postoperative Day 1, and anticoagulants for 5 days preoperatively and postoperative Day 1.

ResultsThe postoperative bleeding rate in the antithrombotic group was 23.3%, significantly higher than the 2.0% observed in the non-antithrombotic group. Significant differences were seen in patients in the antithrombotic group with and without postoperative bleeding according to ESD duration p = 0.041, PPI + mucosal protective agent combination therapy p = 0.039, and LDA + warfarin combination therapy p < 0.001. Multivariate analysis of these factors yielded odds ratios of 1.04 for ESD duration, 14.83 for LDA + warfarin combination therapy, and 0.27 for PPI + mucosal protective agent combination therapy.

ConclusionsThe risk of postoperative hemorrhage following gastric ESD was higher in patients with antithrombotic therapy than in those without that therapy. Among these patients, LDA + warfarin combination therapy and longer ESD duration were significant risk factors for postoperative bleeding. On the contrary, a mucosal protective agent to PPI therapy, lowering the odds ratio for postoperative bleeding, which suggests that the addition of a mucosal protective agent might be effective in preventing post-ESD hemorrhage in patients on antithrombotic therapy.

KeywordsAntithrombotic agents Endoscopic submucosal dissection Gastroprotective agent Peptic ulcer Proton-pump inhibitor AbbreviationsESDEndoscopic submucosal dissection

LDALow-dose aspirin

PPIProton-pump inhibitor

PT-INRProthrombin time-international normalized ratio

APTTActivated partial thromboplastin time


H. pyloriHelicobacter pylori.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-230X-13-136 contains supplementary material, which is available to authorized users.

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Autor: Toshihisa Takeuchi - Kazuhiro Ota - Satoshi Harada - Shoko Edogawa - Yuichi Kojima - Satoshi Tokioka - Eiji Umegaki - Kazuh


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