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Risk factors for postoperative bleeding after gastric endoscopic submucosal dissection in patients under antithrombotics

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World Journal of Gastrointestinal Endoscopy 2016年第7期8卷 349-356页

作者： yuji shindo Satohiro Matsumoto Hiroyuki Miyatani Yukio Yoshida Hirosato Mashima Department of Gastroenterology Jichi Medical University Saitama Medical Center

AIM: To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection(ESD) based on the latest ***: A total of 262 gastric neoplasms were treated by ESD at our center during a 2-year period from October 2012. We analyzed the data of these cases retrospectively to identify the risk factors for postESD ***: Of the 48(18.3%) cases on antithrombotic treatment, 10 were still receiving antiplatelet drugs perioperatively, 13 were on heparin replacement after oral anticoagulant withdrawal, and the antithrombotic therapy was discontinued perioperatively in 25 cases. Postoperative bleeding occurred in 23 cases(8.8%). The postoperative bleeding rate in the heparin replacement group was 61.5%, significantly higher than that in the non-antithrombotic therapy group(6.1%). Univariate analysis identified history of antithrombotic drug use, heparin replacement, hemodialysis, cardiovascular disease, diabetes mellitus, elevated prothrombin timeinternational normalized ratio, and low hemoglobin level on admission as risk factors for post ESD bleeding. Multivariate analysis identified only heparin replacement(OR = 13.7, 95%CI: 1.2-151.3, P = 0.0329) as a significant risk factor for post-ESD ***: Continued administration of antiplatelet agents, based on the guidelines, was not a risk factor for postoperative bleeding after gastric ESD; however, heparin replacement, which is recommended after withdrawal of oral anticoagulants, was identified as a significant risk factor.

关键词： Postoperative bleeding Antithrombotic treatment Gastric neoplasms Endoscopic submucosal dissection

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