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

Ono Shoko; Ieko Masahiro; Tanaka Ikko; Shimoda Yoshihiko; Ono Masayoshi; Yamamoto Keiko; Sakamoto Naoya

doi:10.5230/jgc.2022.22.e2

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자료유형: 학술저널

저자정보: Ono Shoko (Division of Endoscopy Hokkaido University Hospital Sapporo Japan.) Ieko Masahiro (Department of Clinical Laboratory Iwate Prefectural Chubu Hospital Kitakami Japan.) Tanaka Ikko (Department of Gastroenterology and Hepatology Graduate School of Medicine and Faculty of Medicine H) Shimoda Yoshihiko (Department of Gastroenterology and Hepatology Graduate School of Medicine and Faculty of Medicine H) Ono Masayoshi (Department of Gastroenterology and Hepatology Graduate School of Medicine and Faculty of Medicine H) Yamamoto Keiko (Department of Gastroenterology and Hepatology Graduate School of Medicine and Faculty of Medicine H) Sakamoto Naoya (Department of Gastroenterology and Hepatology Graduate School of Medicine and Faculty of Medicine H)

저널정보: 대한위암학회 Journal of Gastric Cancer Journal of Gastric Cancer 제22권 제1호

발행연도: 2022.3

수록면: 47 - 55 (9page)

DOI: 10.5230/jgc.2022.22.e2

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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.

#Gastric cancer #Endoscopic submucosal dissection #Factor Xa inhibitor #Hemorrhage

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