Do antiplatelets increase the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms?

Abstract

Introduction: It is rarely known whether antiplatelets increase the risk of bleeding after endoscopic submucosal dissection (ESD). This study was designed to evaluate the effect of antiplatelets on post-ESD bleeding.

Methods: This study involved 1591 gastric neoplasms (815 adenoma and 776 early gastric cancers) in 1503 patients who had ESD between April 2005 and April 2010. Primary outcome event was defined as overt hematemesis/hematochezia, a drop of hemoglobin >2 g/dL from baseline, or requirement of endoscopic hemostasis, angiographic embolization and/or transfusion.

Results: Of 1591 subjects, 274 took antiplatelets, among whom 102 discontinued them for 7 days or more before ESD. Post-ESD bleeding occurred in 94 subjects including 20 from the continuation group, 6 from the withdrawal group, and 68 from the no-antiplatelet group. In univariate analysis, antiplatelets, early gastric cancer (EGC), comorbidity and specimen diameter were related to post-ESD bleeding. In multivariate analysis, EGC (odds ration [OR] 1.839

95% confidence interval [CI], 1.168-2.896, P = .009), comorbidity (OR 2.246

95% CI, 1.280-3.939, P = .005), and specimen diameter (OR 2.315

95% CI, 1.282-4.180, P = .005) were independent risk factors of post-ESD bleeding, whereas antiplatelet usage was not (OR 1.596

95% CI, 0.877-2.903, P = .126). In subgroup analysis, continuous antiplatelet usage was not found to be an independent risk factor of post-ESD bleeding in multivariate analysis (OR, 2.027

P = .146). Among 102 subjects who discontinued antiplatelets, 1 developed an acute cerebral infarction (1.0%).

Conclusions: In ESD for antiplatelet users, continuous administration was not found to have an independent significant association with bleeding. (Gastrointest Endosc 2012

75:719-27.)