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Endoscopic mucosal desorasis (ESD) is a general-purpose minimally invasive treatment for early gastric cancer (EGC) that is negative for lymph nodes and has relatively good long-term results compared to surgical treatment.
, however, the incidence of post-ESD delayed bleeding is generally between 3.1% and 6.5%.
However, we know that in an aging society, the number of patients taking antithrombotic drugs as a preventive therapy against cardiovascular disease is increasing year by year, so whether the risk of delayed bleeding after TREATMENT with ESD will increase is a question that we need to pay more attention to in the context of antithrombotic drugs (including anti-thrombosis and antiplatelet drugs).
anticoagulants, including warfarin and directly active oral anticoagulants (DOACs), in the past, the preoperative discontinuation of heparin bridging therapy (HBT) and warfarin therapy to maximize the prevention of thrombotic surgery-related bleeding, but some studies have shown that the probability of gastrointestinal bleeding in patients treated by DOACs has not decreased.
, in this study, researchers conducted a nationwide multicenter study in Japan comparing the clinical efficacy of various DOAC and conventional warfarin seismoration in the stomach.
researchers reviewed 728 patients with stomach tumors who received anticoagulants and ESD treatment in 25 medical facilities in Japan. A total of 261 patients received DOAC in
, including Dabiga Group (92), Levachaban (103), Apixaban (45) and Idosaban (21), while 467 patients received warfarin treatment.
14% of patients taking DOAC had delayed bleeding, similar to those receiving warfarin (18%).
patients treated with dabiga had significantly lower delayed bleeding rates than patients treated with warfarin and lower than in other DOAC patients.
multi-factor analysis showed that the age of 65 years, receiving a variety of anti-suppositories, multiple lesions and lesions size of 30 mm are independent risk factors, and the discontinuation of anticoagulants and bleeding risk is associated.
multivariate analysis in patients receiving DOAC, dabiga group therapy was associated with a significantly reduced risk of delayed bleeding.
: The probability of delayed bleeding after various drugs ESD finally researchers said: DOAC's effect on delayed bleeding varies from drug to drug, but dabbiga therapy is associated with the lowest risk of delayed bleeding.
changing oral anticoagulants to dabiga during perioperative may be a reasonable option to reduce the risk of delayed bleeding after gastric ESD.
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