Zhu He, Li Fudong, Tao Ke, Liu Mingqing, Xu Hong
Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China.
J Gastroenterol Hepatol. 2021 Sep;36(9):2363-2374. doi: 10.1111/jgh.15527. Epub 2021 May 5.
Oral anticoagulants are risk factors for post-endoscopic resection bleeding. We aimed to conduct a systematic review and meta-analysis for the risks of post-procedural bleeding (PPB) for direct oral anticoagulants (DOACs) and warfarin following endoscopic resection.
Two independent reviewers searched PubMed, Web of Science, Embase, and Cochrane Library. The Newcastle-Ottawa Scale score was used to assess the quality of the studies, the pooled odds ratio (OR) to present PPB results, and the funnel plots to assess publication bias. The Higgins I statistic was employed to determine the variation across studies due to heterogeneity.
We reviewed 30 articles. PPB occurred in 586 patients on DOACs and 1782 on warfarin. The patients on DOACs had a significantly lower overall risk of PPB compared with those on warfarin (OR, 0.867, 95% confidence interval, 0.771-0.975; P = 0.017, I = 1.6%). Cumulative meta-analysis showed that the PPB rate of DOACs has the trend to be lower than that of warfarin with publication year and sample size. For the subgroup of endoscopic submucosal dissection, the PPB of DOACs was significantly lower than that of warfarin (OR, 0.786; 95% confidence interval, 0.633-0.976; P = 0.029, I = 0%). No significant difference was observed between DOACs and warfarin for anticoagulant strategies, endoscopic procedures, and lesion location.
Compared with warfarin, DOACs have the possibility to significantly decrease the risk of PPB following endoscopic resection, especially for endoscopic submucosal dissection.
口服抗凝剂是内镜切除术后出血的危险因素。我们旨在对直接口服抗凝剂（DOACs）和华法林在内镜切除术后发生术后出血（PPB）的风险进行系统评价和荟萃分析。
两名独立的评价者检索了PubMed、科学网、Embase和Cochrane图书馆。采用纽卡斯尔-渥太华量表评分评估研究质量，用合并比值比（OR）呈现PPB结果，用漏斗图评估发表偏倚。采用Higgins I统计量确定研究间因异质性导致的差异。
我们回顾了30篇文章。服用DOACs的586例患者和服用华法林的1782例患者发生了PPB。与服用华法林的患者相比，服用DOACs的患者发生PPB的总体风险显著更低（OR为0.867，95%置信区间为0.771-0.975；P = 0.017，I = 1.6%）。累积荟萃分析表明，随着发表年份和样本量的增加，DOACs的PPB发生率有低于华法林的趋势。对于内镜黏膜下剥离术亚组，DOACs的PPB显著低于华法林（OR为0.786；95%置信区间为0.633-0.976；P = 0.029，I = 0%）。在抗凝策略、内镜操作和病变部位方面，DOACs与华法林之间未观察到显著差异。
与华法林相比，DOACs有可能显著降低内镜切除术后PPB的风险，尤其是在内镜黏膜下剥离术中。
