title: Clinical problems with antithrombotic therapy for endoscopic submucosal dissection for gastric neoplasms.
abstract: Endoscopic submucosal dissection (ESD) is minimally invasive and thus has become a widely accepted treatment for gastric neoplasms, particularly for patients with comorbidities. Antithrombotic agents are used to prevent thrombotic events in patients with comorbidities such as cardio-cerebrovascular diseases and atrial fibrillation. With appropriate cessation, antithrombotic therapy does not increase delayed bleeding in low thrombosis-risk patients. However, high thrombosis-risk patients are often treated with combination therapy with antithrombotic agents and occasionally require the continuation of antithrombotic agents or heparin bridge therapy (HBT) in the perioperative period. Dual antiplatelet therapy (DAPT), a representative combination therapy, is frequently used after placement of drug-eluting stents and has a high risk of delayed bleeding. In patients receiving DAPT, gastric ESD may be postponed until DAPT is no longer required. HBT is often required for patients treated with anticoagulants and has an extremely high bleeding risk. The continuous use of warfarin or direct oral anticoagulants may be possible alternatives. Here, we show that some antithrombotic therapies in high thrombosis-risk patients increase delayed bleeding after gastric ESD, whereas most antithrombotic therapies do not. The management of high thrombosis-risk patients is crucial for improved outcomes.
authors.affiliation: Toshiyuki Yoshio, Junko Fujisaki, Department of Gastroenterology, Cancer Institute Hospital, Tokyo 135-8550, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yoshio
authors.affiliation: Toshiyuki Yoshio, Junko Fujisaki, Department of Gastroenterology, Cancer Institute Hospital, Tokyo 135-8550, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Toshiyuki Yoshio, Junko Fujisaki, Department of Gastroenterology, Cancer Institute Hospital, Tokyo 135-8550, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Toshiyuki Yoshio, Junko Fujisaki, Department of Gastroenterology, Cancer Institute Hospital, Tokyo 135-8550, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Iijima
authors.affiliation: Toshiyuki Yoshio, Junko Fujisaki, Department of Gastroenterology, Cancer Institute Hospital, Tokyo 135-8550, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsujii
authors.affiliation: Toshiyuki Yoshio, Junko Fujisaki, Department of Gastroenterology, Cancer Institute Hospital, Tokyo 135-8550, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Fujisaki
authors.affiliation: Toshiyuki Yoshio, Junko Fujisaki, Department of Gastroenterology, Cancer Institute Hospital, Tokyo 135-8550, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Takehara
keywords: Antithrombotic therapy; Delayed bleeding; Dual antiplatelet therapy; Endoscopic submucosal dissection; Heparin bridge therapy