Table 2.
Endoscopic submucosal dissection in patients treated with antithrombotic agents n (%)
| Ref. | Patients n, lesions n | En-bloc resection, with R0, % | Perforation | Late bleeding | HR No., bleeding | Thrombogenic event |
| Ono et al[21] | 471, 56 | 96.4/82.1 | 1 (1.8) | 6 (10.7) | 1, 3 (33) | 0 (0) |
| Lim et al[24] | 274, ND | NE | 0 (0) | 26 (12.6)2 | NA | 1 (0.5)3 |
| Koh et al[26] | 175, ND | NE | NE | 17 (9.7)4 | NA | 0 (0) |
| Takeuchi et al[27] | 90, 90 | NE | NE | 21 (23.3)5 | 12, 21 (57) | 1 (1) |
| Yoshio et al[22] | 24, 24 | 100/100 | 0 (0) | 9 (38)6 | 9, 24 (38) | 1 (4.2) |
Forty-four low-risk patients stopped treatment with antithrombotic agents for 1 wk before and after endoscopic submucosal dissection (ESD). Three high-risk patients underwent intravenous heparin replacement during the cessation period;
A total of 274 patients were treated with antiplatelet medication, 102 of whom discontinued the use of these drugs for 7 d or more before ESD, whereas the remaining patients continued use;
One (1%) of the 102 patients who discontinued the use of antiplatelet medication developed an acute cerebral infarction;
Antithrombotic drug therapy was principally interrupted preoperatively and restarted when hemostasis was confirmed by second-look endoscopy. The rate of early postoperative bleeding during the first 5 postoperative days was 4%, and the rate of subsequent bleeding was 5.7%;
All patients commenced treatment with proton pump inhibitors immediately following surgery. Antiplatelet agents were discontinued for 7 d preoperatively until postoperative day 1, and anticoagulants were discontinued for 5 d preoperatively until postoperative day 1. A total of 46 patients received low-dose aspirin (LDA) only, 23 received LDA + thienopyridine, and 21 received LDA + warfarin. Anticoagulants were discontinued from preoperative day 4 to postoperative day 2. Heparin was substituted for anticoagulants after the latter were discontinued;
All patients underwent intravenous heparin replacement during the cessation period because of an increased risk of thromboembolism. HR: Heparin replacement; NA: Not applicable; NE: Not evaluated.