INTRODUCTION 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 (2-3 days after ESD) resumption groups. We used inverse probability of treatment weighting 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 inverse probability of treatment weighting adjustment, the early resumption group did not significantly increase delayed bleeding compared with the delayed resumption group (odds ratio 1.05; 95% confidence interval 0.78-1.42; P = 0.73). However, it significantly reduced the risk of thromboembolic events (odds ratio 0.45; 95% confidence interval 0.25-0.82; P < 0.01). DISCUSSION Resuming DOACs the day after colorectal ESD was associated with reduced thromboembolic events without significant increase in risk of delayed bleeding.

中文翻译：

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结直肠内窥镜粘膜下剥离术后直接口服抗凝剂恢复的时间：日本的一项全国性研究。


引言 随着直接口服抗凝剂 （DOAC） 的使用越来越多，围绕内窥镜粘膜下剥离术 （ESD） 管理这些药物至关重要。然而，由于需要大量病例，缺乏检查恢复时间的研究，导致国际指南中的建议各不相同。我们旨在使用日本的全国数据库对结直肠 ESD 后 DOAC 的恢复时间进行比较研究。方法 我们使用 2012 年至 2023 年的诊断程序组合数据库对结直肠 ESD 进行了回顾性队列研究。使用 DOAC 以外的抗凝剂的患者被排除在外，仅纳入 3 天内恢复 DOAC 的患者。从符合条件的患者中，我们将他们分为早期 （ESD 后 1 天） 和延迟 （ESD 后 2-3 天） 复效组。我们使用治疗加权的逆概率来评估 30 天内的延迟出血和血栓栓塞事件。延迟出血定义为 ESD 后需要内窥镜止血或输血的出血。结果 在 176,139 例结直肠 ESD 中，3,550 例涉及 DOAC 使用者，其中 2,698 例 （76%） 被归类为早期复用组，852 例 （24%） 被归类为延迟复用组。治疗权重调整逆概率后，与延迟恢复组相比，早期恢复组延迟出血未显著增加 （比值比 1.05;95% 置信区间 0.78-1.42;P = 0.73）。然而，它显著降低了血栓栓塞事件的风险 （比值比 0.45;95% 置信区间 0.25-0.82;P < 0.01）。讨论 在结直肠 ESD 后第二天恢复 DOAC 与血栓栓塞事件减少相关，而延迟出血的风险没有显着增加。