Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants  

作　　者：Mitsushige Sugimoto Masaki Murata Takashi Kawai 

机构地区：[1]Department of Gastroenterological Endoscopy,Tokyo Medical University Hospital,Tokyo 160-0023,Japan [2]Department of Gastroenterology,National Hospital Organization Kyoto Medical Center,Kyoto 612-8555,Japan

出　　处：《World Journal of Gastroenterology》2023年第19期2916-2931,共16页世界胃肠病学杂志（英文版）

基　　金：Supported by the Grant-in-Aid for Scientific Research in Japan,No.21K07949.

摘　　要：Delayed bleeding is a major and serious adverse event of endoscopic submucosal dissection(ESD)for early-stage gastrointestinal tumors.The rate of post-ESD bleeding for gastric cancer is higher(around 5%-8%)than that for esophagus,duodenum and colon cancer(around 2%-4%).Although investigations into the risk factors for post-ESD bleeding have identified several procedure-,lesion-,physician-and patient-related factors,use of antithrombotic drugs,especially anticoagulants[direct oral anticoagulants(DOACs)and warfarin],is thought to be the biggest risk factor for post-ESD bleeding.In fact,the post-ESD bleeding rate in patients receiving DOACs is 8.7%-20.8%,which is higher than that in patients not receiving anticoagulants.However,because clinical guidelines for management of ESD in patients receiving DOACs differ among countries,it is necessary for endoscopists to identify ways to prevent post-ESD delayed bleeding in clinical practice.Given that the pharmacokinetics(e.g.,plasma DOAC level at both trough and T_(max))and pharmacodynamics(e.g.,anti-factor Xa activity)of DOACs are related to risk of major bleeding,plasma DOAC level and anti-FXa activity may be useful parameters for monitoring the anti-coagulate effect and identifying DOAC patients at higher risk of post-ESD bleeding.

关 键 词：Direct oral anticoagulants Gastrointestinal tumors Endoscopic submucosal dissection Delayed bleeding Adverse events ANTICOAGULANTS 

分 类 号：R735[医药卫生—肿瘤]