Abstract
BackgroundHeparin 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.MethodsFrom 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.ResultsA 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.ConclusionsThe 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.
Highlights
Heparin bridging therapy (HBT) is related to a high frequency of bleeding after endoscopic mucosal resection (EMR)
We investigated bleeding risk after colonic EMR in patients taking oral coagulants and evaluated whether the continuous use of warfarin and the one-day skip of direct oral anticoagulants (DOACs) could be eligible for perioperative management without HBT
Summarized numerical data were expressed as Patient factors and procedural factors related to bleeding after EMR During the study period, 1734 polyps in 825 patients were resected
Summary
Heparin bridging therapy (HBT) is related to a high frequency of bleeding after endoscopic mucosal resection (EMR). Our aim was to investigate clinical impact of management of oral anticoagulants without HBT in bleeding after colonic EMR. Colonic polypectomy and endoscopic mucosal resection (EMR) are standard procedures for the treatment of colon polyps; these procedures have a risk of bleeding. There have been recent reports on perioperative events in endoscopic resection for patients receiving DOACs [8]. Heparin bridging therapy (HBT), which has been commonly used for the perioperative management of warfarin, is problematic in bleeding and clinical practice.
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