title: Risk factors for postoperative bleeding after gastric endoscopic submucosal dissection in patients under antithrombotics.
abstract: OBJECTIVE
  To evaluate the risk factors for postoperative bleeding after gastric endoscopic submucosal dissection (ESD) based on the latest guidelines.
  
  
  METHODS
  A total of 262 gastric neoplasms were treated by ESD at our center during a 2-year period from October 2012. We analyzed the data of these cases retrospectively to identify the risk factors for post-ESD bleeding.
  
  
  RESULTS
  Of the 48 (18.3%) cases on antithrombotic treatment, 10 were still receiving antiplatelet drugs perioperatively, 13 were on heparin replacement after oral anticoagulant withdrawal, and the antithrombotic therapy was discontinued perioperatively in 25 cases. Postoperative bleeding occurred in 23 cases (8.8%). The postoperative bleeding rate in the heparin replacement group was 61.5%, significantly higher than that in the non-antithrombotic therapy group (6.1%). Univariate analysis identified history of antithrombotic drug use, heparin replacement, hemodialysis, cardiovascular disease, diabetes mellitus, elevated prothrombin time-international normalized ratio, and low hemoglobin level on admission as risk factors for post ESD bleeding. Multivariate analysis identified only heparin replacement (OR = 13.7, 95%CI: 1.2-151.3, P = 0.0329) as a significant risk factor for post-ESD bleeding.
  
  
  CONCLUSIONS
  Continued administration of antiplatelet agents, based on the guidelines, was not a risk factor for postoperative bleeding after gastric ESD; however, heparin replacement, which is recommended after withdrawal of oral anticoagulants, was identified as a significant risk factor.
authors.affiliation: Yuji Shindo, Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida, Hirosato Mashima, Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shindo
authors.affiliation: Yuji Shindo, Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida, Hirosato Mashima, Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan.
authors.forename: Satohiro
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Yuji Shindo, Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida, Hirosato Mashima, Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Miyatani
authors.affiliation: Yuji Shindo, Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida, Hirosato Mashima, Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: Yuji Shindo, Satohiro Matsumoto, Hiroyuki Miyatani, Yukio Yoshida, Hirosato Mashima, Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan.
authors.forename: Hirosato
authors.initials: H
authors.lastname: Mashima
keywords: Antithrombotic treatment; Endoscopic submucosal dissection; Gastric neoplasms; Postoperative bleeding