Potential of Direct Oral Anticoagulant in Bleeding After Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis
Background and Aims An increasing number of patients are undergoing gastric endoscopic submucosal dissection (ESD) with active prescriptions of direct oral anticoagulants (DOACs). Only a few reports have described the effects of DOAC intake on postoperative bleeding. We aimed to investigate the blee...
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| Veröffentlicht in: | Digestive diseases and sciences 2024-03, Vol.69 (3), p.940-948 |
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| creator | Higuchi, Kazutoshi Goto, Osamu Matsuda, Akihisa Nakagome, Shun Habu, Tsugumi Ishikawa, Yumiko Koizumi, Eriko Kirita, Kumiko Noda, Hiroto Onda, Takeshi Akimoto, Teppei Omori, Jun Akimoto, Naohiko Yoshida, Hiroshi Iwakiri, Katsuhiko |
| description | Background and Aims
An increasing number of patients are undergoing gastric endoscopic submucosal dissection (ESD) with active prescriptions of direct oral anticoagulants (DOACs). Only a few reports have described the effects of DOAC intake on postoperative bleeding. We aimed to investigate the bleeding risk associated with DOACs after gastric ESD.
Methods
Clinical studies published up to April 2022 showing bleeding rates after gastric ESD in patients taking DOACs were identified using electronic searches. The primary outcome was the rate of bleeding after gastric ESD in patients receiving DOACs compared to those not receiving antithrombotic therapy. In this meta-analysis, odds ratios (ORs) were calculated and pooled using a random effects model. The secondary outcome was the difference in the bleeding rate between patients treated with DOACs and those treated with warfarin and antiplatelet drugs.
Results
Seven studies were included in this meta-analysis. The pooled analysis showed that DOACs had a higher bleeding rate than non-thrombotic therapy (17.0% vs. 3.4%; OR 5.72; 95% confidence interval [CI], 4.33–7.54;
I
2
= 0%). The bleeding risk associated with DOAC administration was similar to that associated with warfarin (17.0% vs. 20.0%; OR 0.83; 95% CI 0.59–1.18;
I
2
= 0%), whereas it was higher than that associated with antiplatelet administration (16.9% vs. 11.0%; OR 1.63; 95% CI 1.14–2.34;
I
2
= 8%).
Conclusions
This meta-analysis reveals that the bleeding risk of DOACs is higher than that of non-antithrombotics and antiplatelets, whereas it is comparable to that of warfarin. Gastric ESD in patients on anticoagulants requires careful postoperative management. |
| doi_str_mv | 10.1007/s10620-024-08271-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2917552162</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2973571385</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-cd9e3918ad23bca55d331f972564770aa9f8b8311d8d7dd3689c1fd1462241623</originalsourceid><addsrcrecordid>eNp9kc9uFSEUxonR2Gv1BVwYEjdupnLg8mfcjW1tTWpqrK4JF5gbmrlwBUZz38DHljpVExeuOMDv-w6HD6HnQE6AEPm6ABGUdISuO6KohE48QCvgknWUC_UQrQiIVgOII_SklFtCSC9BPEZHTFFOKelX6MfHVH2swUw4jfgsZG8rvs5tO7RTm8x2nkysOET8dvLehbjFw1h9xhem1BwsPo8uFZv2rbyZN7vZptLUZ6GUZhVSfIMHfHMo1e9MM8Sf_Lfgv2MTHf7gq-mGaKZDCeUpejSaqfhn9-sx-vLu_PPpZXd1ffH-dLjqLKOidtb1nvWgjKNsYw3njjEYe9kmXktJjOlHtVEMwCknnWNC9RZGB2tB6RoEZcfo1eK7z-nr7EvVu1Csn9qUPs1F0x4k53RBX_6D3qY5t_feUZJxCUzxRtGFsjmVkv2o9znsTD5oIPouJ73kpFtO-ldOWjTRi3vr9mXe_ZH8DqYBbAFKu4pbn__2_o_tT8FFnaw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2973571385</pqid></control><display><type>article</type><title>Potential of Direct Oral Anticoagulant in Bleeding After Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Higuchi, Kazutoshi ; Goto, Osamu ; Matsuda, Akihisa ; Nakagome, Shun ; Habu, Tsugumi ; Ishikawa, Yumiko ; Koizumi, Eriko ; Kirita, Kumiko ; Noda, Hiroto ; Onda, Takeshi ; Akimoto, Teppei ; Omori, Jun ; Akimoto, Naohiko ; Yoshida, Hiroshi ; Iwakiri, Katsuhiko</creator><creatorcontrib>Higuchi, Kazutoshi ; Goto, Osamu ; Matsuda, Akihisa ; Nakagome, Shun ; Habu, Tsugumi ; Ishikawa, Yumiko ; Koizumi, Eriko ; Kirita, Kumiko ; Noda, Hiroto ; Onda, Takeshi ; Akimoto, Teppei ; Omori, Jun ; Akimoto, Naohiko ; Yoshida, Hiroshi ; Iwakiri, Katsuhiko</creatorcontrib><description>Background and Aims
An increasing number of patients are undergoing gastric endoscopic submucosal dissection (ESD) with active prescriptions of direct oral anticoagulants (DOACs). Only a few reports have described the effects of DOAC intake on postoperative bleeding. We aimed to investigate the bleeding risk associated with DOACs after gastric ESD.
Methods
Clinical studies published up to April 2022 showing bleeding rates after gastric ESD in patients taking DOACs were identified using electronic searches. The primary outcome was the rate of bleeding after gastric ESD in patients receiving DOACs compared to those not receiving antithrombotic therapy. In this meta-analysis, odds ratios (ORs) were calculated and pooled using a random effects model. The secondary outcome was the difference in the bleeding rate between patients treated with DOACs and those treated with warfarin and antiplatelet drugs.
Results
Seven studies were included in this meta-analysis. The pooled analysis showed that DOACs had a higher bleeding rate than non-thrombotic therapy (17.0% vs. 3.4%; OR 5.72; 95% confidence interval [CI], 4.33–7.54;
I
2
= 0%). The bleeding risk associated with DOAC administration was similar to that associated with warfarin (17.0% vs. 20.0%; OR 0.83; 95% CI 0.59–1.18;
I
2
= 0%), whereas it was higher than that associated with antiplatelet administration (16.9% vs. 11.0%; OR 1.63; 95% CI 1.14–2.34;
I
2
= 8%).
Conclusions
This meta-analysis reveals that the bleeding risk of DOACs is higher than that of non-antithrombotics and antiplatelets, whereas it is comparable to that of warfarin. Gastric ESD in patients on anticoagulants requires careful postoperative management.</description><identifier>ISSN: 0163-2116</identifier><identifier>ISSN: 1573-2568</identifier><identifier>EISSN: 1573-2568</identifier><identifier>DOI: 10.1007/s10620-024-08271-6</identifier><identifier>PMID: 38252209</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Anticoagulants ; Anticoagulants - adverse effects ; Biochemistry ; Endoscopic Mucosal Resection - adverse effects ; Endoscopy ; Gastroenterology ; Hepatology ; Humans ; Medicine ; Medicine & Public Health ; Meta-analysis ; Oncology ; Original Article ; Postoperative Hemorrhage - chemically induced ; Postoperative Hemorrhage - epidemiology ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms - drug therapy ; Transplant Surgery ; Warfarin - adverse effects</subject><ispartof>Digestive diseases and sciences, 2024-03, Vol.69 (3), p.940-948</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-cd9e3918ad23bca55d331f972564770aa9f8b8311d8d7dd3689c1fd1462241623</cites><orcidid>0000-0003-4386-6288</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10620-024-08271-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10620-024-08271-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38252209$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Higuchi, Kazutoshi</creatorcontrib><creatorcontrib>Goto, Osamu</creatorcontrib><creatorcontrib>Matsuda, Akihisa</creatorcontrib><creatorcontrib>Nakagome, Shun</creatorcontrib><creatorcontrib>Habu, Tsugumi</creatorcontrib><creatorcontrib>Ishikawa, Yumiko</creatorcontrib><creatorcontrib>Koizumi, Eriko</creatorcontrib><creatorcontrib>Kirita, Kumiko</creatorcontrib><creatorcontrib>Noda, Hiroto</creatorcontrib><creatorcontrib>Onda, Takeshi</creatorcontrib><creatorcontrib>Akimoto, Teppei</creatorcontrib><creatorcontrib>Omori, Jun</creatorcontrib><creatorcontrib>Akimoto, Naohiko</creatorcontrib><creatorcontrib>Yoshida, Hiroshi</creatorcontrib><creatorcontrib>Iwakiri, Katsuhiko</creatorcontrib><title>Potential of Direct Oral Anticoagulant in Bleeding After Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis</title><title>Digestive diseases and sciences</title><addtitle>Dig Dis Sci</addtitle><addtitle>Dig Dis Sci</addtitle><description>Background and Aims
An increasing number of patients are undergoing gastric endoscopic submucosal dissection (ESD) with active prescriptions of direct oral anticoagulants (DOACs). Only a few reports have described the effects of DOAC intake on postoperative bleeding. We aimed to investigate the bleeding risk associated with DOACs after gastric ESD.
Methods
Clinical studies published up to April 2022 showing bleeding rates after gastric ESD in patients taking DOACs were identified using electronic searches. The primary outcome was the rate of bleeding after gastric ESD in patients receiving DOACs compared to those not receiving antithrombotic therapy. In this meta-analysis, odds ratios (ORs) were calculated and pooled using a random effects model. The secondary outcome was the difference in the bleeding rate between patients treated with DOACs and those treated with warfarin and antiplatelet drugs.
Results
Seven studies were included in this meta-analysis. The pooled analysis showed that DOACs had a higher bleeding rate than non-thrombotic therapy (17.0% vs. 3.4%; OR 5.72; 95% confidence interval [CI], 4.33–7.54;
I
2
= 0%). The bleeding risk associated with DOAC administration was similar to that associated with warfarin (17.0% vs. 20.0%; OR 0.83; 95% CI 0.59–1.18;
I
2
= 0%), whereas it was higher than that associated with antiplatelet administration (16.9% vs. 11.0%; OR 1.63; 95% CI 1.14–2.34;
I
2
= 8%).
Conclusions
This meta-analysis reveals that the bleeding risk of DOACs is higher than that of non-antithrombotics and antiplatelets, whereas it is comparable to that of warfarin. Gastric ESD in patients on anticoagulants requires careful postoperative management.</description><subject>Anticoagulants</subject><subject>Anticoagulants - adverse effects</subject><subject>Biochemistry</subject><subject>Endoscopic Mucosal Resection - adverse effects</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Postoperative Hemorrhage - chemically induced</subject><subject>Postoperative Hemorrhage - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stomach Neoplasms - drug therapy</subject><subject>Transplant Surgery</subject><subject>Warfarin - adverse effects</subject><issn>0163-2116</issn><issn>1573-2568</issn><issn>1573-2568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9uFSEUxonR2Gv1BVwYEjdupnLg8mfcjW1tTWpqrK4JF5gbmrlwBUZz38DHljpVExeuOMDv-w6HD6HnQE6AEPm6ABGUdISuO6KohE48QCvgknWUC_UQrQiIVgOII_SklFtCSC9BPEZHTFFOKelX6MfHVH2swUw4jfgsZG8rvs5tO7RTm8x2nkysOET8dvLehbjFw1h9xhem1BwsPo8uFZv2rbyZN7vZptLUZ6GUZhVSfIMHfHMo1e9MM8Sf_Lfgv2MTHf7gq-mGaKZDCeUpejSaqfhn9-sx-vLu_PPpZXd1ffH-dLjqLKOidtb1nvWgjKNsYw3njjEYe9kmXktJjOlHtVEMwCknnWNC9RZGB2tB6RoEZcfo1eK7z-nr7EvVu1Csn9qUPs1F0x4k53RBX_6D3qY5t_feUZJxCUzxRtGFsjmVkv2o9znsTD5oIPouJ73kpFtO-ldOWjTRi3vr9mXe_ZH8DqYBbAFKu4pbn__2_o_tT8FFnaw</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Higuchi, Kazutoshi</creator><creator>Goto, Osamu</creator><creator>Matsuda, Akihisa</creator><creator>Nakagome, Shun</creator><creator>Habu, Tsugumi</creator><creator>Ishikawa, Yumiko</creator><creator>Koizumi, Eriko</creator><creator>Kirita, Kumiko</creator><creator>Noda, Hiroto</creator><creator>Onda, Takeshi</creator><creator>Akimoto, Teppei</creator><creator>Omori, Jun</creator><creator>Akimoto, Naohiko</creator><creator>Yoshida, Hiroshi</creator><creator>Iwakiri, Katsuhiko</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4386-6288</orcidid></search><sort><creationdate>20240301</creationdate><title>Potential of Direct Oral Anticoagulant in Bleeding After Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis</title><author>Higuchi, Kazutoshi ; Goto, Osamu ; Matsuda, Akihisa ; Nakagome, Shun ; Habu, Tsugumi ; Ishikawa, Yumiko ; Koizumi, Eriko ; Kirita, Kumiko ; Noda, Hiroto ; Onda, Takeshi ; Akimoto, Teppei ; Omori, Jun ; Akimoto, Naohiko ; Yoshida, Hiroshi ; Iwakiri, Katsuhiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-cd9e3918ad23bca55d331f972564770aa9f8b8311d8d7dd3689c1fd1462241623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Anticoagulants</topic><topic>Anticoagulants - adverse effects</topic><topic>Biochemistry</topic><topic>Endoscopic Mucosal Resection - adverse effects</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Postoperative Hemorrhage - chemically induced</topic><topic>Postoperative Hemorrhage - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stomach Neoplasms - drug therapy</topic><topic>Transplant Surgery</topic><topic>Warfarin - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Higuchi, Kazutoshi</creatorcontrib><creatorcontrib>Goto, Osamu</creatorcontrib><creatorcontrib>Matsuda, Akihisa</creatorcontrib><creatorcontrib>Nakagome, Shun</creatorcontrib><creatorcontrib>Habu, Tsugumi</creatorcontrib><creatorcontrib>Ishikawa, Yumiko</creatorcontrib><creatorcontrib>Koizumi, Eriko</creatorcontrib><creatorcontrib>Kirita, Kumiko</creatorcontrib><creatorcontrib>Noda, Hiroto</creatorcontrib><creatorcontrib>Onda, Takeshi</creatorcontrib><creatorcontrib>Akimoto, Teppei</creatorcontrib><creatorcontrib>Omori, Jun</creatorcontrib><creatorcontrib>Akimoto, Naohiko</creatorcontrib><creatorcontrib>Yoshida, Hiroshi</creatorcontrib><creatorcontrib>Iwakiri, Katsuhiko</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Digestive diseases and sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Higuchi, Kazutoshi</au><au>Goto, Osamu</au><au>Matsuda, Akihisa</au><au>Nakagome, Shun</au><au>Habu, Tsugumi</au><au>Ishikawa, Yumiko</au><au>Koizumi, Eriko</au><au>Kirita, Kumiko</au><au>Noda, Hiroto</au><au>Onda, Takeshi</au><au>Akimoto, Teppei</au><au>Omori, Jun</au><au>Akimoto, Naohiko</au><au>Yoshida, Hiroshi</au><au>Iwakiri, Katsuhiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Potential of Direct Oral Anticoagulant in Bleeding After Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis</atitle><jtitle>Digestive diseases and sciences</jtitle><stitle>Dig Dis Sci</stitle><addtitle>Dig Dis Sci</addtitle><date>2024-03-01</date><risdate>2024</risdate><volume>69</volume><issue>3</issue><spage>940</spage><epage>948</epage><pages>940-948</pages><issn>0163-2116</issn><issn>1573-2568</issn><eissn>1573-2568</eissn><abstract>Background and Aims
An increasing number of patients are undergoing gastric endoscopic submucosal dissection (ESD) with active prescriptions of direct oral anticoagulants (DOACs). Only a few reports have described the effects of DOAC intake on postoperative bleeding. We aimed to investigate the bleeding risk associated with DOACs after gastric ESD.
Methods
Clinical studies published up to April 2022 showing bleeding rates after gastric ESD in patients taking DOACs were identified using electronic searches. The primary outcome was the rate of bleeding after gastric ESD in patients receiving DOACs compared to those not receiving antithrombotic therapy. In this meta-analysis, odds ratios (ORs) were calculated and pooled using a random effects model. The secondary outcome was the difference in the bleeding rate between patients treated with DOACs and those treated with warfarin and antiplatelet drugs.
Results
Seven studies were included in this meta-analysis. The pooled analysis showed that DOACs had a higher bleeding rate than non-thrombotic therapy (17.0% vs. 3.4%; OR 5.72; 95% confidence interval [CI], 4.33–7.54;
I
2
= 0%). The bleeding risk associated with DOAC administration was similar to that associated with warfarin (17.0% vs. 20.0%; OR 0.83; 95% CI 0.59–1.18;
I
2
= 0%), whereas it was higher than that associated with antiplatelet administration (16.9% vs. 11.0%; OR 1.63; 95% CI 1.14–2.34;
I
2
= 8%).
Conclusions
This meta-analysis reveals that the bleeding risk of DOACs is higher than that of non-antithrombotics and antiplatelets, whereas it is comparable to that of warfarin. Gastric ESD in patients on anticoagulants requires careful postoperative management.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38252209</pmid><doi>10.1007/s10620-024-08271-6</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-4386-6288</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Anticoagulants Anticoagulants - adverse effects Biochemistry Endoscopic Mucosal Resection - adverse effects Endoscopy Gastroenterology Hepatology Humans Medicine Medicine & Public Health Meta-analysis Oncology Original Article Postoperative Hemorrhage - chemically induced Postoperative Hemorrhage - epidemiology Retrospective Studies Risk Factors Stomach Neoplasms - drug therapy Transplant Surgery Warfarin - adverse effects |
| title | Potential of Direct Oral Anticoagulant in Bleeding After Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis |
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