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KMID : 1188320180120040393
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Gut and Liver
2018 Volume.12 No. 4 p.393 ~ p.401
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Continuous Use of Thienopyridine May Be as Safe as Low-Dose Aspirin in Endoscopic Resection of Gastric Tumors
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Oh Soo-Yeon
Kim Sang-Gyun
Kim Jung
Choi Ji-Min
Lim Joo-Hyun
Yang Hyo-Joon
Park Jae-Yong
Han Seung-Jun
Kim Jue-Lie
Chung Hyun-Soo
Jung Hyun-Chae
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Abstract
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Background/Aims: Current guidelines recommend withholding antiplatelets for 5-7 days before high-risk endoscopic procedures. We investigated whether this reduces post-endoscopic submucosal dissection (ESD) bleeding.
Methods: Gastric ESD cases with antiplatelets were retorospectively reviewed. Withholding antiplatelets for 5=7 days before ESD was defined as cessation and 0-4 days as continuation. The rate and risk of post-ESD bleeding according to the types and cessation of antiplatelets were assessed.
Results: Among the 215 patients (117 adenoma and 98 early gastric cancer), 161 patients were on single (94 aspirin, 56 thienopyridine, and 11 other agents), 51 on dual, and 3 on triple antiplatelets. Post-ESD bleeding rates were 12.8% in aspirin users, 3.6% in thienopyridine, 27.5% in dual, 33.3% in triple therapy, and 9.7% in the cessation and 15.0% in the continuation group. Multiple antiplatelets (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.01 to 5.76) and specimen size ≥ 5.5 cm (OR, 2.84; 95% CI, 1.04 to 7.73) were the risk of bleeding, while continuation of thienopyridine (OR, 0.23; 95% CI, 0.05 to 1.09) and antiplatelets (OR, 1.83; 95% CI, 0.68 to 4.94) did not increase the risk of bleeding.
Conclusions: Continuing thienopyridine and aspirin did not increase the risk of post-ESD. Multiple antiplatelet therapy and a large specimen size were independent risk factors of post-ESD bleeding.
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KEYWORD
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Antiplatelet, Aspirin, Thienopyridine, Endoscopic submucosal dissection, Post-endoscopic submucosal dissection bleeding
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