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


METHODS
Retrospective study.


METHODS
Single, tertiary-care referral center.


METHODS
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.


METHODS
ESD.


METHODS
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%).


CONCLUSIONS
A retrospective, single-center analysis.


CONCLUSIONS
In ESD for antiplatelet users, continuous administration was not found to have an independent significant association with bleeding.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Joo Hyun
JH
Lim
Sang Gyun
SG
Kim
Ji Won
JW
Kim
Yoon Jin
YJ
Choi
Jieun
J
Kwon
Ji Yeon
JY
Kim
Yun Bin
YB
Lee
Jeongmin
J
Choi
Jong Pil
JP
Im
Joo Sung
JS
Kim
Hyun Chae
HC
Jung
In Sung
IS
Song
D000236:Adenoma / Q000601:surgery*; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D016001:Confidence Intervals; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
D010975:Platelet Aggregation Inhibitors