Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis.

Katsuaki Inagaki,Takahiro Kotachi,Hirosato Tamari,Fumiaki Tanino,Yuki Kamigaichi,Yuji Urabe,Yasutsugu Shimohara,Shinji Tanaka,Ryo Yuge,Tomoyuki Nishimura,Ken Yamashita,Yuki Okamoto,Kenichi Yoshimura,Hidenori Tanaka,Shiro Oka,Yasuhiko Kitadai,Noriko Yamamoto,Amosy M'Koma

doi:10.1155/2021/9415387

Katsuaki Inagaki, Takahiro Kotachi + Show 16 more

Open Access

https://doi.org/10.1155/2021/9415387

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Abstract

The Japan Gastroenterological Endoscopy Society (JGES) guidelines recommend continued warfarin treatment during gastroenterological endoscopic procedures with a high risk of bleeding as an alternative to heparin replacement in patients on warfarin therapy. However, there is insufficient evidence to support the use of warfarin in colorectal endoscopic resection (ER). The present study is aimed at verifying the risk of bleeding after ER for colorectal neoplasia (CRN) in patients with continued warfarin use. This was a single-center retrospective cohort study using clinical records. We assessed 126 consecutive patients with 159 CRNs who underwent ER (endoscopic mucosal resection, 146 cases; endoscopic submucosal dissection, 13 cases) at Hiroshima University Hospital between January 2014 and December 2019. Patients were divided into two groups: the heparin replacement group (79 patients with 79 CRNs) and the continued warfarin group (47 patients with 80 CRNs). One-to-one propensity score matching was performed to compare the bleeding rate after ER between the groups. The rate of bleeding after ER was significantly higher in the heparin replacement group than in the continued warfarin group for both before (10.1% vs. 1.3%, respectively; P = 0.0178) and after (11.9% vs. 0%, respectively; P = 0.0211) propensity score matching. None of the patients experienced thromboembolic events during the perioperative period. The risk of bleeding after colorectal ER was significantly lower in patients with continued warfarin use than in those with heparin replacement. Our data supports the recommendations of the latest JGES guidelines for patients receiving warfarin therapy.

Highlights

Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide [1]
We previously reported that anticoagulant use increased the risk of bleeding after colorectal endoscopic submucosal dissection (ESD) [3]
endoscopic mucosal resection (EMR) was performed in 91.8% (146/159) of colorectal neoplasia (CRN), whereas ESD was performed in 8.2% (13/159) of CRNs

Summary

Introduction

Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide [1]. The population of older individuals and the number of patients receiving antithrombotic agents (antiplatelet agents and anticoagulants) have increased [2]. Endoscopists are increasingly performing more endoscopic resection (ER) for colorectal neoplasia (CRN) in patients on antithrombotic agents. Postprocedural bleeding is one of the most common severe complications of ER. We previously reported that anticoagulant use increased the risk of bleeding after colorectal endoscopic submucosal dissection (ESD) [3].

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