Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis
The Japan Gastroenterological Endoscopy Society (JGES) guidelines recommend continued warfarin treatment during gastroenterological endoscopic procedures with a high risk of bleeding as an alternative to heparin replacement in patients on warfarin therapy. However, there is insufficient evidence to...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2021/9415387 |
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| author | Katsuaki Inagaki Ken Yamashita Shiro Oka Fumiaki Tanino Noriko Yamamoto Yuki Kamigaichi Hirosato Tamari Yasutsugu Shimohara Tomoyuki Nishimura Yuki Okamoto Hidenori Tanaka Takahiro Kotachi Ryo Yuge Yuji Urabe Yasuhiko Kitadai Kenichi Yoshimura Shinji Tanaka |
| author_facet | Katsuaki Inagaki Ken Yamashita Shiro Oka Fumiaki Tanino Noriko Yamamoto Yuki Kamigaichi Hirosato Tamari Yasutsugu Shimohara Tomoyuki Nishimura Yuki Okamoto Hidenori Tanaka Takahiro Kotachi Ryo Yuge Yuji Urabe Yasuhiko Kitadai Kenichi Yoshimura Shinji Tanaka |
| author_sort | Katsuaki Inagaki |
| collection | DOAJ |
| description | The Japan Gastroenterological Endoscopy Society (JGES) guidelines recommend continued warfarin treatment during gastroenterological endoscopic procedures with a high risk of bleeding as an alternative to heparin replacement in patients on warfarin therapy. However, there is insufficient evidence to support the use of warfarin in colorectal endoscopic resection (ER). The present study is aimed at verifying the risk of bleeding after ER for colorectal neoplasia (CRN) in patients with continued warfarin use. This was a single-center retrospective cohort study using clinical records. We assessed 126 consecutive patients with 159 CRNs who underwent ER (endoscopic mucosal resection, 146 cases; endoscopic submucosal dissection, 13 cases) at Hiroshima University Hospital between January 2014 and December 2019. Patients were divided into two groups: the heparin replacement group (79 patients with 79 CRNs) and the continued warfarin group (47 patients with 80 CRNs). One-to-one propensity score matching was performed to compare the bleeding rate after ER between the groups. The rate of bleeding after ER was significantly higher in the heparin replacement group than in the continued warfarin group for both before (10.1% vs. 1.3%, respectively; P=0.0178) and after (11.9% vs. 0%, respectively; P=0.0211) propensity score matching. None of the patients experienced thromboembolic events during the perioperative period. The risk of bleeding after colorectal ER was significantly lower in patients with continued warfarin use than in those with heparin replacement. Our data supports the recommendations of the latest JGES guidelines for patients receiving warfarin therapy. |
| format | Article |
| id | doaj-art-c1d9268fe68645e9a6d0ebe62fa98f70 |
| institution | DOAJ |
| issn | 1687-630X |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-c1d9268fe68645e9a6d0ebe62fa98f702025-08-20T03:23:27ZengWileyGastroenterology Research and Practice1687-630X2021-01-01202110.1155/2021/9415387Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching AnalysisKatsuaki Inagaki0Ken Yamashita1Shiro Oka2Fumiaki Tanino3Noriko Yamamoto4Yuki Kamigaichi5Hirosato Tamari6Yasutsugu Shimohara7Tomoyuki Nishimura8Yuki Okamoto9Hidenori Tanaka10Takahiro Kotachi11Ryo Yuge12Yuji Urabe13Yasuhiko Kitadai14Kenichi Yoshimura15Shinji Tanaka16Department of Gastroenterology and MetabolismDepartment of EndoscopyDepartment of Gastroenterology and MetabolismDepartment of Gastroenterology and MetabolismDepartment of Gastroenterology and MetabolismDepartment of Gastroenterology and MetabolismDepartment of Gastroenterology and MetabolismDepartment of Gastroenterology and MetabolismDepartment of Gastroenterology and MetabolismDepartment of Gastroenterology and MetabolismDepartment of EndoscopyDepartment of EndoscopyDepartment of EndoscopyDivision of Regeneration and Medicine Center for Translational and Clinical ResearchFaculty of Human Culture and ScienceMedical Center for Translational and Clinical ResearchDepartment of EndoscopyThe Japan Gastroenterological Endoscopy Society (JGES) guidelines recommend continued warfarin treatment during gastroenterological endoscopic procedures with a high risk of bleeding as an alternative to heparin replacement in patients on warfarin therapy. However, there is insufficient evidence to support the use of warfarin in colorectal endoscopic resection (ER). The present study is aimed at verifying the risk of bleeding after ER for colorectal neoplasia (CRN) in patients with continued warfarin use. This was a single-center retrospective cohort study using clinical records. We assessed 126 consecutive patients with 159 CRNs who underwent ER (endoscopic mucosal resection, 146 cases; endoscopic submucosal dissection, 13 cases) at Hiroshima University Hospital between January 2014 and December 2019. Patients were divided into two groups: the heparin replacement group (79 patients with 79 CRNs) and the continued warfarin group (47 patients with 80 CRNs). One-to-one propensity score matching was performed to compare the bleeding rate after ER between the groups. The rate of bleeding after ER was significantly higher in the heparin replacement group than in the continued warfarin group for both before (10.1% vs. 1.3%, respectively; P=0.0178) and after (11.9% vs. 0%, respectively; P=0.0211) propensity score matching. None of the patients experienced thromboembolic events during the perioperative period. The risk of bleeding after colorectal ER was significantly lower in patients with continued warfarin use than in those with heparin replacement. Our data supports the recommendations of the latest JGES guidelines for patients receiving warfarin therapy.http://dx.doi.org/10.1155/2021/9415387 |
| spellingShingle | Katsuaki Inagaki Ken Yamashita Shiro Oka Fumiaki Tanino Noriko Yamamoto Yuki Kamigaichi Hirosato Tamari Yasutsugu Shimohara Tomoyuki Nishimura Yuki Okamoto Hidenori Tanaka Takahiro Kotachi Ryo Yuge Yuji Urabe Yasuhiko Kitadai Kenichi Yoshimura Shinji Tanaka Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis Gastroenterology Research and Practice |
| title | Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis |
| title_full | Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis |
| title_fullStr | Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis |
| title_full_unstemmed | Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis |
| title_short | Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis |
| title_sort | risk of bleeding after colorectal endoscopic resection in patients with continued warfarin use compared to heparin replacement a propensity score matching analysis |
| url | http://dx.doi.org/10.1155/2021/9415387 |
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