Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul, 03080, Korea.
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Sci Rep. 2021 Apr 30;11(1):9399. doi: 10.1038/s41598-021-88656-z.
Direct oral anticoagulants (DOACs) are widely prescribed for the prevention of stroke in elderly patients with atrial fibrillation and approved indication for DOAC has been expanded. We aimed to evaluate the risk of delayed bleeding in patients who had taken DOAC and underwent endoscopic submucosal dissection (ESD) for gastric neoplasms. We included consecutive patients who underwent ESD between January 2016 and July 2019 in Seoul National University Hospital. Patients were divided into four groups (no med; no medication, DOAC, WFR; warfarin, anti-PLT; anti-platelet agent) according to the medications they had been taken before the procedure. We defined delayed bleeding as obvious post-procedural gastrointestinal bleeding sign including hematemesis or melena combined with hemoglobin drop ≥ 2 g/dL. Among 1634 patients enrolled in this study, 23 (1.4%) patients had taken DOAC and they usually stopped the medication for 2 days before the ESD and resumed within 1 or 2 days. We compared rates of delayed bleeding between groups. Delayed bleeding rates of the groups of no med, DOAC, WFR, and anti-PLT were 2.1% (32/1499) 8.7% (2/23), 14.3% (2/14), 11.2% (11/98), respectively (P < 0.001). However, there was no difference of delayed bleeding rate between no med and DOAC group after propensity score matching (no med vs DOAC, 1.7% vs 10.0%, P = 0.160). Taking DOAC was not associated statistically with post-ESD bleeding when adjusted by age, sex, comorbidities and characteristics of target lesion (Adjusted Odds Ratio: 2.4, 95% Confidence intervals: 0.41-13.73, P = 0.335). Crude rate of bleeding in DOAC users seemed to be higher than no medication group after performing ESD with 2 days of medication cessation. When adjusted by age, sex, and comorbidity, however, this difference seems to be small, which suggests that gastric post-ESD bleeding may be influenced by patients' underlying condition in addition to medication use.
直接口服抗凝剂（DOACs）被广泛用于预防老年房颤患者的中风，并且 DOAC 的适应证已被扩大。我们旨在评估接受 DOAC 治疗并因胃肿瘤而行内镜黏膜下剥离术（ESD）的患者延迟出血的风险。我们纳入了 2016 年 1 月至 2019 年 7 月在首尔国立大学医院接受 ESD 的连续患者。根据手术前服用的药物，患者分为四组（无药物；无药物、DOAC、WFR；华法林、抗血小板；抗血小板药物）。我们将延迟出血定义为明显的术后胃肠道出血征象，包括呕血或黑便，同时血红蛋白下降≥2g/dL。在这项研究中纳入的 1634 名患者中，23 名（1.4%）患者服用了 DOAC，他们通常在 ESD 前停止用药 2 天，然后在 1 至 2 天内恢复用药。我们比较了各组的延迟出血率。无药物、DOAC、WFR 和抗血小板组的延迟出血率分别为 2.1%（32/1499）、8.7%（2/23）、14.3%（2/14）、11.2%（11/98）（P<0.001）。然而，在倾向评分匹配后，无药物和 DOAC 组的延迟出血率无差异（无药物 vs DOAC，1.7% vs 10.0%，P=0.160）。在调整年龄、性别、合并症和目标病变特征后，服用 DOAC 与 ESD 后出血无统计学关联（调整后的优势比：2.4，95%置信区间：0.41-13.73，P=0.335）。在停止用药 2 天后进行 ESD 时，DOAC 使用者的出血率似乎高于无药物组。然而，在调整年龄、性别和合并症后，这种差异似乎很小，这表明胃 ESD 后出血可能不仅受药物使用的影响，还受患者基础疾病的影响。
