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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结直肠内镜粘膜下剥离术后直接口服抗凝剂恢复的时机：日本的一项全国性研究。


简介 随着直接口服抗凝剂 (DOAC) 的使用越来越多，在内镜粘膜下剥离术 (ESD) 周围管理这些药物至关重要。然而，由于需要大量病例，缺乏对恢复时间的研究，导致国际指南的建议各不相同。我们的目的是使用日本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 我们利用 2012 年至 2023 年诊断程序组合数据库对结直肠 ESD 进行了回顾性队列研究。排除使用 DOAC 以外的抗凝剂的患者，仅纳入 3 天内恢复 DOAC 的患者。我们将符合条件的患者分为早期（ESD 后第二天）和延迟（ESD 后 2-3 天）恢复组。我们使用治疗权重的逆概率来评估 30 天内的延迟出血和血栓栓塞事件。迟发性出血定义为ESD后需要内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 用户，其中 2,698 例 (76%) 属于早期恢复组，852 例 (24%) 属于延迟恢复组。经过治疗权重逆概率调整后，与延迟恢复组相比，早期恢复组并没有显着增加延迟出血（比值比1.05；95%置信区间0.78-1.42；P = 0.73）。然而，它显着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 结直肠 ESD 后第二天恢复 DOAC 与血栓栓塞事件的减少相关，且延迟出血的风险不会显着增加。