| アブストラクト | OBJECTIVES: With the increasing use of direct oral anticoagulants (DOACs), managing these agents around endoscopic submucosal dissection (ESD) is crucial. However, due to the need for a large number of cases, studies examining the timing of resumption are lacking, resulting in varied recommendations across international guidelines. We aimed to perform a comparative study about the resumption timing of DOACs after colorectal ESD using a nationwide database in Japan. METHODS: We conducted a retrospective cohort study on colorectal ESD using the Diagnosis Procedure Combination database from 2012 to 2023. Patients using anticoagulants other than DOACs were excluded, and only those who resumed DOACs within 3 days were included. From eligible patients, we divided them into early (the day after ESD) and delayed (2 to 3 days after ESD) resumption groups. We used inverse probability of treatment weighting (IPTW) to assess the delayed bleeding and thromboembolic events within 30 days. Delayed bleeding was defined as bleeding requiring endoscopic hemostasis or blood transfusion after ESD. RESULTS: Of 176,139 colorectal ESDs, 3,550 involved DOAC users, with 2,698 (76%) categorized as early resumption and 852 (24%) categorized as delayed resumption groups. After IPTW adjustment, the early resumption group did not significantly increase delayed bleeding compared to the delayed resumption group (OR, 1.05; 95% CI, 0.78-1.42; P = 0.73). However, it significantly reduced the risk of thromboembolic events (OR, 0.45; 95% CI, 0.25-0.82; P < 0.01). CONCLUSIONS: Resuming DOACs the day after colorectal ESD was associated with reduced thromboembolic events without significant increase in risk of delayed bleeding. |
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| 組織名 | Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1,;Okamoto, Kamakura, Kanagawa 247-8533, Japan.;Department of Health Data Science, Yokohama City University, 22-2, Seto,;Kanazawa-Ku, Yokohama, Kanagawa 236-0027, Japan.;TXP Medical Co., Ltd. 41-1 H1O Kanda 706, Kanda Higashimatsushita-cho,;Chiyoda-ku, Tokyo 101-0042, Japan.;Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.;Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. |
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