Do antiplatelets increase the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms?

Abstract

BACKGROUND:

It is rarely known whether antiplatelets increase the risk of bleeding after endoscopic submucosal dissection (ESD).

OBJECTIVE:

To evaluate the effect of antiplatelets on post-ESD bleeding.

DESIGN:

Retrospective study.

SETTING:

Single, tertiary-care referral center.

PATIENTS:

This study involved 1591 gastric neoplasms (815 adenomas and 776 early gastric cancers) in 1503 patients who had ESD between April 2005 and April 2010.

INTERVENTION:

ESD.

MAIN OUTCOME MEASUREMENTS:

Overt hematemesis/hematochezia, a drop of hemoglobin >2 g/dL from baseline, or requirement of endoscopic hemostasis, angiographic embolization, and/or transfusion.

RESULTS:

Of 1591 subjects, 274 took antiplatelets, among whom 102 discontinued them for 7 days or more before ESD. Post-ESD bleeding occurred in 94 subjects including 20 from the continuation group, 6 from the withdrawal group, and 68 from the no-antiplatelet group. In univariate analysis, antiplatelets, early gastric cancer (EGC), comorbidity, and specimen diameter were related to post-ESD bleeding. In multivariate analysis, EGC (odds ratio [OR] 1.839; 95% confidence interval [CI], 1.168-2.896; P = .009), comorbidity (OR 2.246; 95% CI, 1.280-3.939; P = .005), and specimen diameter (OR 2.315; 95% CI, 1.282-4.180; P = .005) were independent risk factors of post-ESD bleeding, whereas antiplatelet usage was not (OR 1.596; 95% CI, 0.877-2.903; P = .126). In subgroup analysis, continuous antiplatelet usage was not found to be an independent risk factor of post-ESD bleeding in multivariate analysis (OR 2.027; P = .146). Among 102 subjects who discontinued antiplatelets, 1 developed an acute cerebral infarction (1.0%).

LIMITATION:

A retrospective, single-center analysis.

CONCLUSION:

In ESD for antiplatelet users, continuous administration was not found to have an independent significant association with bleeding.

• Authors: Joo Hyun Lim, Sang Gyun Kim, Ji Won Kim, Yoon Jin Choi, Jieun Kwon, Ji Yeon Kim, Yun Bin Lee, Jeongmin Choi, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung, In Sung Song
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 75 Issue 4 Pg. 719-27 (Apr 2012) ISSN: 1097-6779 [Electronic] United States
• PMID: 22317881 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors

Topics

• Adenoma (surgery)
• Aged
• Carcinoma (pathology, surgery)
• Confidence Intervals
• Female
• Gastric Mucosa (surgery)
• Gastrointestinal Hemorrhage (chemically induced)
• Gastroscopy
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Postoperative Hemorrhage (chemically induced)
• Retrospective Studies
• Risk Factors
• Stomach Neoplasms (pathology, surgery)