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Optimal timing for resuming antithrombotic agents and risk factors for delayed bleeding after endoscopic resection of colorectal tumors.

Beppu K, Osada T, Sakamoto N, Shibuya T, Matsumoto K, Nagahara A, Terai T, Ogihara T, Watanabe S - Gastroenterol Res Pract (2014)

Bottom Line: By multivariate analysis resumption of anticoagulants within 5 days was a significant risk factor for delayed bleeding (OR 10.2; 95% CI = 2.7-38.3; P = 0.0006).Other patient- and tumor-factors were not significant.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.

ABSTRACT
Aim. To examine optimal timing for resuming antithrombotic agents and risk factors for delayed bleeding after endoscopic resection of colorectal tumors. Method. Of 1,970 polyps larger than 10 mm removed by polypectomy, endoscopic mucosal resection, or endoscopic submucosal dissection, delayed bleeding, which was designated as bleeding that occurred 6 or more hours after endoscopic treatment, occurred in 52 cases (2.6%); 156 nonbleeding cases matched for age and gender were controls in this single-institution retrospective case-control study. We investigated (1) patient-factors: resuming antithrombotic agents within 5 days following endoscopic resection, hypertension, and diabetes mellitus; and (2) tumor-factors: morphology, size, location, and resection technique by conditional logistic regression. Results. By multivariate analysis resumption of anticoagulants within 5 days was a significant risk factor for delayed bleeding (OR 10.2; 95% CI = 2.7-38.3; P = 0.0006). But resuming a thienopyridine within 5 days was not (OR 0.9; 95% CI = 0.1-2.6; P = 0.40). Other patient- and tumor-factors were not significant. Conclusion. Resuming anticoagulants within 5 days after endoscopic treatment was associated with delayed bleeding whereas resuming thienopyridines was not.

No MeSH data available.


Related in: MedlinePlus

Flow diagram showing the process for analysis in the case-control study.
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Related In: Results  -  Collection


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fig1: Flow diagram showing the process for analysis in the case-control study.

Mentions: From January 2006 to October 2012, 1,970 cases with polyps of the colon and rectum, measuring larger than 10 mm, were removed by polypectomy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD) at our hospital. All procedures were performed by 5 expert endoscopists. Patients were instructed to contact the endoscopist immediately if they had bloody feces. We identified patients who reported delayed bleeding by examining in patients' records for the 30-day period after the procedure and checking for hospital visits to ensure that we did not overlook any cases of delayed bleeding in this study. “Cases” were defined as those patients who developed delayed bleeding, which was designated as bleeding that occurred 6 or more hours after endoscopic treatment. For such cases, after admission, second-look colonoscopy was performed to identify the origin of bleeding, and endoscopic hemostasis was performed when active bleeding was found. “Controls” were defined as patients who underwent endoscopic treatment with colonoscopy but did not develop delayed bleeding and were matched for age and gender with cases. Controls were selected in a 3 : 1 ratio compared with cases (Figure 1).


Optimal timing for resuming antithrombotic agents and risk factors for delayed bleeding after endoscopic resection of colorectal tumors.

Beppu K, Osada T, Sakamoto N, Shibuya T, Matsumoto K, Nagahara A, Terai T, Ogihara T, Watanabe S - Gastroenterol Res Pract (2014)

Flow diagram showing the process for analysis in the case-control study.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4273557&req=5

fig1: Flow diagram showing the process for analysis in the case-control study.
Mentions: From January 2006 to October 2012, 1,970 cases with polyps of the colon and rectum, measuring larger than 10 mm, were removed by polypectomy, endoscopic mucosal resection (EMR), or endoscopic submucosal dissection (ESD) at our hospital. All procedures were performed by 5 expert endoscopists. Patients were instructed to contact the endoscopist immediately if they had bloody feces. We identified patients who reported delayed bleeding by examining in patients' records for the 30-day period after the procedure and checking for hospital visits to ensure that we did not overlook any cases of delayed bleeding in this study. “Cases” were defined as those patients who developed delayed bleeding, which was designated as bleeding that occurred 6 or more hours after endoscopic treatment. For such cases, after admission, second-look colonoscopy was performed to identify the origin of bleeding, and endoscopic hemostasis was performed when active bleeding was found. “Controls” were defined as patients who underwent endoscopic treatment with colonoscopy but did not develop delayed bleeding and were matched for age and gender with cases. Controls were selected in a 3 : 1 ratio compared with cases (Figure 1).

Bottom Line: By multivariate analysis resumption of anticoagulants within 5 days was a significant risk factor for delayed bleeding (OR 10.2; 95% CI = 2.7-38.3; P = 0.0006).Other patient- and tumor-factors were not significant.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.

ABSTRACT
Aim. To examine optimal timing for resuming antithrombotic agents and risk factors for delayed bleeding after endoscopic resection of colorectal tumors. Method. Of 1,970 polyps larger than 10 mm removed by polypectomy, endoscopic mucosal resection, or endoscopic submucosal dissection, delayed bleeding, which was designated as bleeding that occurred 6 or more hours after endoscopic treatment, occurred in 52 cases (2.6%); 156 nonbleeding cases matched for age and gender were controls in this single-institution retrospective case-control study. We investigated (1) patient-factors: resuming antithrombotic agents within 5 days following endoscopic resection, hypertension, and diabetes mellitus; and (2) tumor-factors: morphology, size, location, and resection technique by conditional logistic regression. Results. By multivariate analysis resumption of anticoagulants within 5 days was a significant risk factor for delayed bleeding (OR 10.2; 95% CI = 2.7-38.3; P = 0.0006). But resuming a thienopyridine within 5 days was not (OR 0.9; 95% CI = 0.1-2.6; P = 0.40). Other patient- and tumor-factors were not significant. Conclusion. Resuming anticoagulants within 5 days after endoscopic treatment was associated with delayed bleeding whereas resuming thienopyridines was not.

No MeSH data available.


Related in: MedlinePlus