Continuous Use of Antithrombotic Medications during Peri-ESD Period for Colorectal Lesions: A Propensity Score Matched Study.

OBJECTIVE: The aim of this study was to elucidate the use of antithrombotic medications the peri-colorectal endoscopic submucosal dissection (ESD) period.

METHODS: This study included 468 patients with colorectal epithelial neoplasms treated by ESD, consisting of 82 under antithrombotic medications and 386 patients without the medications. Among patients taking antithrombotic medications, antithrombotic agents were continued during the peri-ESD period. Clinical characteristics and adverse events were compared after propensity score matching.

RESULTS: Before and after propensity score matching, post-colorectal ESD bleeding rate was higher in patients continuing antithrombotic medications (19.5% and 21.6%, respectively) than in those not taking antithrombotic medications (2.9% and 5.4%, respectively). In the Cox-regression analysis, continuation of antithrombotic medications was associated with post-ESD bleeding risk (hazard ratio 3.73, 95% confidence interval 1.2-11.6, p<0.05) compared to patients without antithrombotic therapy. All patients who experienced post-ESD bleeding were successfully treated by endoscopic hemostasis procedure or conservative therapy.

CONCLUSIONS: Continuation of antithrombotic medications during the peri-colorectal ESD period increases the risk of bleeding. However, the continuation may be acceptable under careful monitoring for post-ESD bleeding.