Antithrombotic Therapy Increases the Risk of Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis
Whether antithrombotic agent (ATA) usage increases the risk of gastric post-endoscopic submucosal dissection (ESD) bleeding remains controversial. The aim of this study was to elucidate the effects of usage, type, and cessation timing of ATA on post-ESD bleeding. A total of 4775 early gastric cancer...
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MDPI AG
2023-05-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/10/2844 |
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| author | Tae-Se Kim Byung-Hoon Min Sun-Young Baek Kyunga Kim Yang-Won Min Hyuk Lee Jun-Haeng Lee Poong-Lyul Rhee Jae J. Kim |
| author_facet | Tae-Se Kim Byung-Hoon Min Sun-Young Baek Kyunga Kim Yang-Won Min Hyuk Lee Jun-Haeng Lee Poong-Lyul Rhee Jae J. Kim |
| author_sort | Tae-Se Kim |
| collection | DOAJ |
| description | Whether antithrombotic agent (ATA) usage increases the risk of gastric post-endoscopic submucosal dissection (ESD) bleeding remains controversial. The aim of this study was to elucidate the effects of usage, type, and cessation timing of ATA on post-ESD bleeding. A total of 4775 early gastric cancer patients undergoing ESD were analyzed; 1:3 propensity score matching between ATA and non-ATA groups resulted in 318 and 767 matched patients in each group, respectively. Outcomes were compared between the two groups using a generalized estimating equation method. After matching, post-ESD bleeding rates in ATA users and non-users were 9.1% and 4.2%, respectively (<i>p</i> = 0.001). In multivariable analysis, ATA usage was independently associated with an increased risk of post-ESD bleeding (adjusted odds ratio: 2.28, 95% confidence interval: 1.34–3.86). Both the continued or insufficient cessation groups and the sufficient cessation group had an increased incidence of post-ESD bleeding compared to their matched controls (12.5% versus 5.2%, <i>p</i> = 0.048; 8.1% versus 3.9%, <i>p</i> = 0.014). Post-ESD bleeding rates in antiplatelet agent users were significantly higher than those of their matched controls (8.3% versus 4.2%, <i>p</i> = 0.010). ATA usage increased the risk of post-ESD bleeding even after its sufficient cessation. Careful observation after ESD is required regardless of the cessation status of ATA. |
| first_indexed | 2024-03-11T03:51:31Z |
| format | Article |
| id | doaj.art-389ee0943a304082be65597a702301ea |
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| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T03:51:31Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-389ee0943a304082be65597a702301ea2023-11-18T00:49:45ZengMDPI AGCancers2072-66942023-05-011510284410.3390/cancers15102844Antithrombotic Therapy Increases the Risk of Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched AnalysisTae-Se Kim0Byung-Hoon Min1Sun-Young Baek2Kyunga Kim3Yang-Won Min4Hyuk Lee5Jun-Haeng Lee6Poong-Lyul Rhee7Jae J. Kim8Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of KoreaBiomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of KoreaBiomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of KoreaDepartment of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of KoreaWhether antithrombotic agent (ATA) usage increases the risk of gastric post-endoscopic submucosal dissection (ESD) bleeding remains controversial. The aim of this study was to elucidate the effects of usage, type, and cessation timing of ATA on post-ESD bleeding. A total of 4775 early gastric cancer patients undergoing ESD were analyzed; 1:3 propensity score matching between ATA and non-ATA groups resulted in 318 and 767 matched patients in each group, respectively. Outcomes were compared between the two groups using a generalized estimating equation method. After matching, post-ESD bleeding rates in ATA users and non-users were 9.1% and 4.2%, respectively (<i>p</i> = 0.001). In multivariable analysis, ATA usage was independently associated with an increased risk of post-ESD bleeding (adjusted odds ratio: 2.28, 95% confidence interval: 1.34–3.86). Both the continued or insufficient cessation groups and the sufficient cessation group had an increased incidence of post-ESD bleeding compared to their matched controls (12.5% versus 5.2%, <i>p</i> = 0.048; 8.1% versus 3.9%, <i>p</i> = 0.014). Post-ESD bleeding rates in antiplatelet agent users were significantly higher than those of their matched controls (8.3% versus 4.2%, <i>p</i> = 0.010). ATA usage increased the risk of post-ESD bleeding even after its sufficient cessation. Careful observation after ESD is required regardless of the cessation status of ATA.https://www.mdpi.com/2072-6694/15/10/2844anticoagulantsantiplateletsendoscopic submucosal dissectionpostoperative hemorrhage |
| spellingShingle | Tae-Se Kim Byung-Hoon Min Sun-Young Baek Kyunga Kim Yang-Won Min Hyuk Lee Jun-Haeng Lee Poong-Lyul Rhee Jae J. Kim Antithrombotic Therapy Increases the Risk of Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis Cancers anticoagulants antiplatelets endoscopic submucosal dissection postoperative hemorrhage |
| title | Antithrombotic Therapy Increases the Risk of Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis |
| title_full | Antithrombotic Therapy Increases the Risk of Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis |
| title_fullStr | Antithrombotic Therapy Increases the Risk of Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis |
| title_full_unstemmed | Antithrombotic Therapy Increases the Risk of Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis |
| title_short | Antithrombotic Therapy Increases the Risk of Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Propensity Score-Matched Analysis |
| title_sort | antithrombotic therapy increases the risk of bleeding after endoscopic submucosal dissection for early gastric cancer a propensity score matched analysis |
| topic | anticoagulants antiplatelets endoscopic submucosal dissection postoperative hemorrhage |
| url | https://www.mdpi.com/2072-6694/15/10/2844 |
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