BACKGROUND Heparin bridging therapy (HBT) is indeed related to a high frequency of bleeding after endoscopic mucosal resection (EMR). In this study, our aim was to investigate clinical impact of management of oral anticoagulants without HBT in bleeding after colonic EMR. METHODS From data for patients who underwent consecutive colonic EMR, the relationships of patient factors and procedural factors with the risk of bleeding were analysed. Our management of antithrombotic agents was based on the shortest cessation as follows: the administration of warfarin was generally continued within the therapeutic range, and direct oral anticoagulants (DOACs) were not administered on the day of the procedure. We calculated bleeding risks after EMR in patients who used antithrombotic agents and evaluated whether perioperative management of anticoagulants without HBT was beneficial for bleeding. RESULTS A total of 1734 polyps in 825 EMRs were analysed. Bleeding occurred in 4.0% of the patients and 1.9% of the polyps. The odds ratios for bleeding using multivariate logistic regression analysis were 3.67 in patients who used anticoagulants and 4.95 in patients who used both anticoagulants and antiplatelet agents. In patients with one-day skip of DOACs, bleeding occurred in 6.5% of the polyps, and there were no significant differences in bleeding risk between HBT and continuous warfarin or one-day skip DOACs. CONCLUSIONS The use of oral anticoagulants was related to bleeding after colonic EMR, and perioperative management of oral anticoagulants based on the shortest cessation without HBT would be clinically acceptable.

中文翻译：

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结肠内窥镜黏膜切除术后围手术期口服抗凝剂对出血的临床影响。

背景技术肝素桥接治疗（HBT）确实与内窥镜黏膜切除术（EMR）后的高频率出血有关。在这项研究中，我们的目的是调查在结肠EMR术后出血时不使用HBT口服抗凝剂的临床效果。方法从连续进行结肠EMR的患者的数据中，分析患者因素和手术因素与出血风险的关系。我们的抗血栓药管理基于以下最短的停止时间：华法林的给药通常在治疗范围内继续进行，并且在手术当天不给予直接口服抗凝剂（DOAC）。我们计算了使用抗栓剂的患者在EMR后的出血风险，并评估了围手术期使用不含HBT的抗凝剂对出血是否有益。结果共分析了825例EMR中的1734例息肉。在4.0％的患者和1.9％的息肉中发生出血。使用多元logistic回归分析的出血比值比在使用抗凝剂的患者中为3.67，在同时使用抗凝剂和抗血小板剂的患者中为4.95。一日跳过DOAC的患者中，有6.5％的息肉发生出血，HBT与连续华法林或一日跳过DOAC的出血风险无显着差异。结论口服抗凝剂的使用与结肠EMR术后出血有关，