Continuous Use of Thienopyridine May Be as Safe as Low-Dose Aspirin in Endoscopic Resection of Gastric Tumors
Gut and Liver 2018³â 12±Ç 4È£ p.393 ~ p.401
¿À¼ö¿¬(Oh Soo-Yeon) - Seoul National University College of Medicine Department of Internal Medicine
±è»ó±Õ(Kim Sang-Gyun) - Seoul National University College of Medicine Department of Internal Medicine
±èÁ¤(Kim Jung) - Seoul National University College of Medicine Department of Internal Medicine
ÃÖÁö¹Î(Choi Ji-Min) - Seoul National University Hospital Healthcare System Gangnam Center Department of Internal Medicine
ÀÓÁÖÇö(Lim Joo-Hyun) - Seoul National University Hospital Healthcare System Gangnam Center Department of Internal Medicine
¾çÈ¿ÁØ(Yang Hyo-Joon) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Internal Medicine
¹ÚÀç¿ë(Park Jae-Yong) - Chung-Ang University College of Medicine Chung-Ang University Hospital Department of Internal Medicine
ÇѽÂÁØ(Han Seung-Jun) - Seoul National University College of Medicine Department of Internal Medicine
±èÁÖ¸®(Kim Jue-Lie) - Seoul National University College of Medicine Department of Internal Medicine
Á¤Çö¼ö(Chung Hyun-Soo) - Seoul National University College of Medicine Department of Internal Medicine
Á¤Çöä(Jung Hyun-Chae) - Seoul National University College of Medicine Department of Internal Medicine
Abstract
Background/Aims: Current guidelines recommend withholding antiplatelets for 5-7 days before high-risk endoscopic procedures. We investigated whether this reduces post-endoscopic submucosal dissection (ESD) bleeding.
Methods: Gastric ESD cases with antiplatelets were retorospectively reviewed. Withholding antiplatelets for 5=7 days before ESD was defined as cessation and 0-4 days as continuation. The rate and risk of post-ESD bleeding according to the types and cessation of antiplatelets were assessed.
Results: Among the 215 patients (117 adenoma and 98 early gastric cancer), 161 patients were on single (94 aspirin, 56 thienopyridine, and 11 other agents), 51 on dual, and 3 on triple antiplatelets. Post-ESD bleeding rates were 12.8% in aspirin users, 3.6% in thienopyridine, 27.5% in dual, 33.3% in triple therapy, and 9.7% in the cessation and 15.0% in the continuation group. Multiple antiplatelets (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.01 to 5.76) and specimen size ¡Ã 5.5 cm (OR, 2.84; 95% CI, 1.04 to 7.73) were the risk of bleeding, while continuation of thienopyridine (OR, 0.23; 95% CI, 0.05 to 1.09) and antiplatelets (OR, 1.83; 95% CI, 0.68 to 4.94) did not increase the risk of bleeding.
Conclusions: Continuing thienopyridine and aspirin did not increase the risk of post-ESD. Multiple antiplatelet therapy and a large specimen size were independent risk factors of post-ESD bleeding.
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Antiplatelet, Aspirin, Thienopyridine, Endoscopic submucosal dissection, Post-endoscopic submucosal dissection bleeding
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Continuing thienopyridine and aspirin did not increase the risk of post-ESD.