Multicenter Study of the Hemorrhage Risk after Endoscopic Mucosal Resection Associated with Direct Oral Anticoagulants.

Ritsu Yasuda,Ken Inoue,Kiyoshi Ogiso,Yuji Naito,Kotaro Okuda,Akira Tomie,Koichi Soga,Naohisa Yoshida,Takashi Okuda,Daisuke Hasegawa,Yoshikazu Inagaki,Ryohei Hirose,Yoshito Itoh,Yutaka Inada,Osamu Dohi,Takaaki Murakami

doi:10.1155/2019/5743561

Abstract

Backgrounds and Aims Recently, direct oral anticoagulants (DOACs) have become widely used for preventing thromboembolism. However, postoperative hemorrhage (POH) is a major complication associated with endoscopic mucosal resection (EMR) for colorectal lesions. In this multicenter study, we analyzed the incidence of POH after EMR associated with DOACs and explored the associated risk factors. Materials and Methods This study was a multicenter retrospective cohort study conducted at 8 Japanese institutions. A total of 2062 cases that underwent EMR for colorectal lesions at these 8 institutions from October 2016 to September 2017 were analyzed. The cases were divided into 4 groups: the DOAC group (63 cases), warfarin group (34 cases), antiplatelet group (185 cases), and no antithrombotics group (1780 cases). In all lesions of the DOAC and warfarin groups, endoscopic clipping was performed after EMR. The rate of POH in the DOAC group, patients' clinical characteristics, the risk factors of POH, and the rate of thromboembolism due to stopping DOACs were compared with other groups. Results The rates of POH were 7.9%∗ (5/63), 2.9% (1/34), 3.2% (6/185), and 0.6%∗∗ (11/1780) in the DOAC, warfarin, antiplatelet, and no antithrombotics groups, respectively (∗ vs. ∗∗, p < 0.001). Regarding risk factors, the tumor size with POH (mm) was significantly bigger than that without POH (16.2 ± 8.3 vs. 7.2 ± 4.9, p < 0.001). There were no significant differences in the rates of POH based on the type of DOAC. In addition, no thromboembolisms occurred due to stopping of DOAC treatment. Conclusions Patients receiving DOACs had significantly higher rates of POH after EMR than those without antithrombotics.

Highlights

With the growing elderly population, the number of patients receiving antithrombotics is increasing globally [1]
The rate of postoperative hemorrhage (POH) after Endoscopic mucosal resection (EMR) in the Direct oral anticoagulants (DOACs) group was 7.9%, which was significantly higher than the no antithrombotics group
Singh et al reported that the rate of POH after polypectomy for colorectal neoplasia was significantly higher in patients taking clopidogrel than patients without it [18]

Summary

Introduction

With the growing elderly population, the number of patients receiving antithrombotics is increasing globally [1]. Rates of colorectal neoplasia, such as colorectal cancer and colorectal adenoma, are increasing due to the aging of the population [2]. The number of patients receiving antithrombotics is increasing along with the age at which. Physicians should be familiar with performing EMR in patients receiving these drugs. Direct oral anticoagulants (DOACs) are antithrombotic drugs that have been used to prevent cerebrovascular disease and deep vein thrombosis for about a decade [5]. DOACs have superior pharmacological properties, including (i) a better and rapid dose response, (ii) less difference in anticoagulant activity between individuals, (iii) no influence by vitamin K intake, and (iv) very few drug interactions. The risk of nonprocedural-related gastrointestinal (GI) bleeding is higher with some DOACs than with warfarin [6]

Methods

Results

Discussion

Conclusion