title: Endoscopic submucosal dissection for early gastric cancer without interruption of warfarin and aspirin.
abstract: Many guidelines for the management of antithrombotic therapy in endoscopic procedures state that warfarin should be replaced by heparin in high risk endoscopic procedures. However, heparin bridging therapy is costly, requires a long hospital stay, and is indicated as a risk factor for bleeding after endoscopic submucosal dissection (ESD). It is not yet clear whether it is better to perform gastric ESD on continuous warfarin therapy or heparin bridging therapy. We report the case of a 65-year-old Japanese man who had been diagnosed with early gastric cancer. He had a past medical history of metallic valve replacement for mitral valve regurgitation, coronary artery disease with bare metal stent, and coronary artery bypass graft. Warfarin and low dose aspirin had been used to prevent thromboembolic events in the metallic mitral valve and coronary artery stent. We performed gastric ESD safely on continuous warfarin and low dose aspirin without any complications.
authors.affiliation: Teikyo University Chiba Medical Center - Gastroenterology, Ichihara, Chiba, Japan.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Tounou
authors.affiliation: Shin-Tokyo Hospital - Gastroenterology, Matsudo, Chiba, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Shin-Tokyo Hospital - Gastroenterology, Matsudo, Chiba, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Hosono
authors.affiliation: Shin-Tokyo Hospital - Gastroenterology, Matsudo, Chiba, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Harada
authors.affiliation: Shin-Tokyo Hospital - Gastroenterology, Matsudo, Chiba, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hayasaka
authors.affiliation: Shin-Tokyo Hospital - Gastroenterology, Matsudo, Chiba, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Katsuyama
authors.affiliation: Shin-Tokyo Hospital - Gastroenterology, Matsudo, Chiba, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suehiro
authors.affiliation: Shin-Tokyo Hospital - Gastroenterology, Matsudo, Chiba, Japan.
authors.forename: Seishi
authors.initials: S
authors.lastname: Nagano
authors.affiliation: Shin-Tokyo Hospital - Gastroenterology, Matsudo, Chiba, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Shimizu