Journal Basic Info

  • Impact Factor: 1.995**
  • H-Index: 8
  • ISSN: 2474-1647
  • DOI: 10.25107/2474-1647
**Impact Factor calculated based on Google Scholar Citations. Please contact us for any more details.

Major Scope

  •  Vascular Surgery
  •  Obstetrics Surgery
  •  Neurological Surgery
  •  Ophthalmic Surgery
  •  General Surgery
  •  Orthopaedic Surgery
  •  Gastroenterological Surgery
  •  Oral and Maxillofacial Surgery


Citation: Clin Surg. 2018;3(1):2102.Research Article | Open Access

Postoperative Bleeding after Gastric Endoscopic Submucosal Dissection in Patients on Anticoagulant Therapy, Especially Warfarin and DOAC

Tsukasa Furuhata, Shu Hoteya, Toshiro Iizuka, Akihiro Yamada, Kosuke Nomura, Yasutaka Kuribayashi, Daisuke Kikuchi, Akira Matsui, Satoshi Yamashta and Toshifumi Mitani

Departments of Gastroenterology, Toranomon Hospital, Japan

*Correspondance to: Tsukasa Furuhata 

 PDF  Full Text DOI: 10.25107/2474-1647.2102


Background and Aims: It is controversial whether anticoagulant therapy increases the risk of bleeding after Endoscopic Submucosal Dissection (ESD). The aim of this study is to evaluate the effects of anticoagulant therapy on gastric ESD.Methods: Patients who underwent gastric ESD in Toranomon Hospital between April 2005 and July 2017 were enrolled. The risk of post-ESD bleeding was evaluated using multivariate cox proportional hazards analysis.Results: Of 1979 patients enrolled, 49 were taking anticoagulant agent; 25 discontinued warfarin and switched to heparin alternative therapy during ESD, whereas 24 discontinued DOAC (Direct oral anticoagulant). During 2 months of the entire observational period, post-ESD bleeding occurred in 88 patients (4.4%): 80 patients without any anticoagulant agent (4.1%), 8 patients with anticoagulant agent (9.1%); 4 patients with a warfarin (16.0%), 4patients with DOAC (16.7%). In multivariate analysis, anticoagulant therapy [hazards ratio (HR) 6.24, 95% confidence interval (CI): 2.93–13.27], warfarin (HR4.19, 95% CI: 2.10–16.62), DOAC (HR6.71, 95% CI: 2.39-18.82) were independent risk factors of post-ESD bleeding.Conclusion: Because anticoagulant therapy significantly increases the risk of post-ESD bleeding, it should be necessary to strictly management at least two weeks after ESD.


ESD, Anticoagulant, DOAC, Warfarin, Gastric tumor

Cite the article

Furuhata T, Hoteya S, Iizuka T, Yamada A, Nomura K, Kuribayashi Y, et al. Postoperative Bleeding after Gastric Endoscopic Submucosal Dissection in Patients on Anticoagulant Therapy, Especially Warfarin and DOAC. Clin Surg. 2018; 3: 2102.

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