Optimal direct oral anticoagulant for upper gastrointestinal endoscopic submucosal dissection.

IF 6.9 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology Pub Date : 2024-11-27 DOI:10.1007/s00535-024-02171-2

Yoshitaka Ono, Waku Hatta, Kunio Tarasawa, Yohei Ogata, Hiroko Abe, Isao Sato, Yutaka Hatayama, Masahiro Saito, Xiaoyi Jin, Kaname Uno, Tomoyuki Koike, Akira Imatani, Shin Hamada, Kenji Fujimori, Kiyohide Fushimi, Atsushi Masamune

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引用次数: 0

Abstract

Background: The patients taking direct oral anticoagulants (DOACs) are at high risk for developing ischemic stroke and delayed bleeding in upper gastrointestinal endoscopic submucosal dissection (ESD). We aimed to identify the optimal DOAC based on both adverse events in upper gastrointestinal ESD.

Methods: A retrospective population-based cohort study was conducted using the Diagnosis Procedure Combination database in Japan. We included patients on a DOAC undergoing upper gastrointestinal ESD between 2012 and 2021. The primary outcomes were ischemic stroke occurring after upper gastrointestinal ESD and delayed bleeding in gastroduodenal and esophageal ESD. Inverse probability weightings were applied to balance the four DOAC groups (dabigatran, rivaroxaban, apixaban, and edoxaban), and logistic regression analyses were performed to compare the outcomes.

Results: We analyzed 9729 patients on a DOAC undergoing upper gastrointestinal ESD. Ischemic stroke developed after upper gastrointestinal ESD in 1.4%, 0.7%, 0.6%, and 0.8% of patients taking dabigatran, rivaroxaban, apixaban, and edoxaban, respectively, after weighting. Rivaroxaban and apixaban showed significantly lower risk of ischemic stroke compared with dabigatran (odds ratio, 0.15 and 0.12, respectively) in standard doses. The delayed bleeding developed after gastroduodenal ESD in 7.6%, 14.6%, 19.2%, and 17.3% of patients taking each DOAC, respectively, with the lowest risk in dabigatran, followed by rivaroxaban. A similar pattern was observed in delayed bleeding in esophageal ESD (3.2%, 5.4%, 7.5%, and 5.5% in each DOAC), but with no significant results.

Conclusions: Rivaroxaban might be an optimal DOAC for upper gastrointestinal ESD showing a lower risk for both ischemic stroke and delayed bleeding.

查看原文本刊更多论文

上消化道内镜黏膜下剥离术的最佳直接口服抗凝剂。

背景：服用直接口服抗凝药（DOAC）的患者在上消化道内镜黏膜下剥离术（ESD）中发生缺血性卒中和延迟出血的风险很高。我们的目的是根据上消化道内镜黏膜下剥离术中的这两种不良事件确定最佳 DOAC：方法：我们利用日本诊断程序组合数据库开展了一项基于人群的回顾性队列研究。我们纳入了 2012 年至 2021 年期间使用 DOAC 进行上消化道 ESD 的患者。主要结果是上消化道ESD后发生的缺血性卒中以及胃十二指肠和食管ESD延迟出血。采用反概率加权法来平衡四个 DOAC 组（达比加群、利伐沙班、阿哌沙班和埃多沙班），并进行逻辑回归分析来比较结果：我们分析了9729例使用DOAC接受上消化道ESD治疗的患者。在服用达比加群、利伐沙班、阿哌沙班和依度沙班的患者中，加权后分别有1.4%、0.7%、0.6%和0.8%的患者在上消化道ESD后发生缺血性卒中。与达比加群相比，利伐沙班和阿哌沙班在标准剂量下发生缺血性中风的风险明显降低（几率比分别为 0.15 和 0.12）。在服用每种 DOAC 的患者中，分别有 7.6%、14.6%、19.2% 和 17.3% 的患者在胃十二指肠 ESD 后发生延迟出血，其中达比加群的风险最低，其次是利伐沙班。在食管ESD延迟出血方面也观察到了类似的模式（每种DOAC分别为3.2%、5.4%、7.5%和5.5%），但结果并不显著：利伐沙班可能是上消化道ESD的最佳DOAC，缺血性卒中和延迟出血的风险都较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastroenterology 医学-胃肠肝病学

CiteScore

12.20

自引率

1.60%

发文量

审稿时长

4-8 weeks

期刊介绍： The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership.