An Analysis of Delayed Bleeding in Cases of Colorectal Endoscopic Submucosal Dissection Due to Types of Direct Oral Anticoagulants in Japan

Naohisa Yoshida; Yoshikazu Hayashi; Daichi Togo; Shiro Oka; Kazunori Takada; Shusei Fukunaga; Yoshinori Morita; Takemasa Hayashi; Kazuhiro Kozuka; Yosuke Tsuji; Takashi Murakami; Takeshi Yamamura; Yoriaki Komeda; Yoji Takeuchi; Kensuke Shinmura; Hiroko Fukuda; Shinji Yoshii; Shoko Ono; Shinichi Katsuki; Kazumasa Kawashima; Daiki Nemoto; Hiroyuki Yamamoto; Yutaka Saito; Naoto Tamai; Aya Iwao; Yuki Itoi; Shigetsugu Tsuji; Yoshikazu Inagaki; Yutaka Inada; Koichi Soga; Daisuke Hasegawa; Takaaki Murakami; Hiroyuki Yoriki; Kohei Fukumoto; Takayuki Motoyoshi; Yasuki Nakatani; Yasushi Sano; Mikitaka Iguchi; Shigehiko Fujii; Hiromitsu Ban; Keita Harada; Koichi Okamoto; Hitoshi Nishiyama; Fumisato Sasaki; Kazujhiro Mizukami; Takashi Shono; Ryo Shimoda; Tadashi Miike; Naoyuki Yamaguchi

doi:10.1016/j.cgh.2023.09.012

An Analysis of Delayed Bleeding in Cases of Colorectal Endoscopic Submucosal Dissection Due to Types of Direct Oral Anticoagulants in Japan

Clin Gastroenterol Hepatol. 2024 Feb;22(2):271-282.e3. doi: 10.1016/j.cgh.2023.09.012. Epub 2023 Sep 22.

Authors

Naohisa Yoshida¹, Yoshikazu Hayashi², Daichi Togo³, Shiro Oka⁴, Kazunori Takada⁵, Shusei Fukunaga⁶, Yoshinori Morita⁷, Takemasa Hayashi⁸, Kazuhiro Kozuka⁹, Yosuke Tsuji¹⁰, Takashi Murakami¹¹, Takeshi Yamamura¹², Yoriaki Komeda¹³, Yoji Takeuchi¹⁴, Kensuke Shinmura¹⁵, Hiroko Fukuda¹⁶, Shinji Yoshii¹⁷, Shoko Ono¹⁸, Shinichi Katsuki¹⁹, Kazumasa Kawashima²⁰, Daiki Nemoto²¹, Hiroyuki Yamamoto²², Yutaka Saito²³, Naoto Tamai²⁴, Aya Iwao²⁵, Yuki Itoi²⁶, Shigetsugu Tsuji²⁷, Yoshikazu Inagaki²⁸, Yutaka Inada²⁹, Koichi Soga³⁰, Daisuke Hasegawa³¹, Takaaki Murakami³², Hiroyuki Yoriki³³, Kohei Fukumoto³⁴, Takayuki Motoyoshi³⁵, Yasuki Nakatani³⁶, Yasushi Sano³⁷, Mikitaka Iguchi³⁸, Shigehiko Fujii³⁹, Hiromitsu Ban⁴⁰, Keita Harada⁴¹, Koichi Okamoto⁴², Hitoshi Nishiyama⁴³, Fumisato Sasaki⁴⁴, Kazujhiro Mizukami⁴⁵, Takashi Shono⁴⁶, Ryo Shimoda⁴⁷, Tadashi Miike⁴⁸, Naoyuki Yamaguchi⁴⁹

Affiliations

¹ Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: [email protected].
² Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
³ Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan.
⁴ Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan.
⁵ Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
⁶ Department of Gastroenterology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan.
⁷ Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Hyogo, Japan.
⁸ Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan.
⁹ Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
¹⁰ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹¹ Department of Gastroenterology, Juntendo University, Tokyo, Japan.
¹² Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
¹³ Department of Gastroenterology, Kindai University, Osaka, Japan.
¹⁴ Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
¹⁵ Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
¹⁶ Department of Gastroenterology, Sasebo City General Hospital, Nagasaki, Japan.
¹⁷ Department of Gastroenterology, Sapporo Medical University, Hokkaido, Japan.
¹⁸ Department of Gastroenterology, Hokkaido University Hospital, Hokkaido, Japan.
¹⁹ Gastroenterology, Otaru Ekisaikai Hospital, Hokkaido, Japan.
²⁰ Department of Endoscopy, Fukushima Medical University, Fukushima, Japan.
²¹ Department of Coloproctology, Fukushima Medical University Aizu Medical Center, Fukushima, Japan.
²² Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
²³ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
²⁴ Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
²⁵ Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Nihon University, Tokyo, Japan.
²⁶ Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan.
²⁷ Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
²⁸ Department of Gastroenterology, Nishizin Hospital, Kyoto, Japan.
²⁹ Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan.
³⁰ Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, Japan.
³¹ Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan.
³² Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan.
³³ Department of Gastroenterology, Otsu City Hospital, Shiga, Japan.
³⁴ Department of Gastroenterology, Nara City Hospital, Nara, Japan.
³⁵ Department of Gastroenterology, Kyoto City Hospital, Kyoto, Japan.
³⁶ Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
³⁷ Gastrointestinal Center, Sano Hospital, Hyogo, Japan.
³⁸ Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.
³⁹ Department of Gastroenterology, Kyoto Katsura Hospital, Kyoto, Japan.
⁴⁰ Department of Gastroenterology, Omi Medical Center, Shiga, Japan.
⁴¹ Department of Gastroenterology, Okayama University, Okayama, Japan.
⁴² Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
⁴³ Department of Gastroenterology, Nagasaki Medical Center, Nagasaki, Japan.
⁴⁴ Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
⁴⁵ Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan.
⁴⁶ Department of Gastroenterology, Kumamoto Central Hospital, Kumamoto, Japan.
⁴⁷ Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan.
⁴⁸ Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
⁴⁹ Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.

PMID: 37743040
DOI: 10.1016/j.cgh.2023.09.012

Abstract

Background & aims: Reported rates of delayed bleeding (DB) after endoscopic resection using direct oral anticoagulants (DOACs) are high and heterogeneous. This large-scale multicenter study analyzed cases of DB after colorectal endoscopic submucosal dissection related to various types of DOACs in Japan (the ABCD-J study) with those associated with warfarin.

Methods: We retrospectively reviewed 1019 lesions in patients treated with DOACs and 459 lesions in patients treated with warfarin among 34,455 endoscopic submucosal dissection cases from 47 Japanese institutions between 2012 and 2021. The DB rate (DBR) with each DOAC was compared with that with warfarin. Risk factors for DB in patients treated with DOACs or warfarin were also investigated.

Results: The mean tumor sizes in the DOAC and warfarin groups were 29.6 ± 14.0 and 30.3 ± 16.4 mm, respectively. In the DOAC group, the DBR with dabigatran (18.26%) was significantly higher than that with apixaban (10.08%, P = .029), edoxaban (7.73%, P = .001), and rivaroxaban (7.21%, P < .001). Only rivaroxaban showed a significantly lower DBR than warfarin (11.76%, P = .033). In the multivariate analysis, heparin bridging therapy (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.27-3.73, P = .005), rectal location (2.01, 1.28-3.16, P = .002), and procedure time ≥55 minutes (2.43, 1.49-3.95, P < .001) were significant risk factors for DB in the DOAC group. The DB risk in the DOAC group (OR, (95% CI)) was 2.13 (1.30-3.50) and 4.53 (2.52-8.15) for 1 and 2 significant risk factors, respectively.

Conclusions: Dabigatran was associated with a higher DBR than other DOACs, and only rivaroxaban was associated with a significantly lower DBR than warfarin.

Keywords: Adenoma; Colorectal Lesions; DOAC; ESD; Polyps.

Publication types

Multicenter Study

MeSH terms

Administration, Oral
Anticoagulants
Atrial Fibrillation* / complications
Colorectal Neoplasms* / complications
Colorectal Neoplasms* / surgery
Dabigatran / adverse effects
Endoscopic Mucosal Resection* / adverse effects
Hemorrhage / chemically induced
Humans
Japan
Retrospective Studies
Rivaroxaban / adverse effects
Warfarin

Substances

Warfarin
Rivaroxaban
Dabigatran
Anticoagulants