Do antiplatelets increase the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms?

Background: It is rarely known whether antiplatelets increase the risk of bleeding after endoscopic submucosal dissection (ESD). Objective: To evaluate the effect of antiplatelets on post-ESD bleeding. Design: Retrospective study. Setting: Single, tertiary-care referral center. Patients: This study involved 1591 gastric neoplasms. (815 adenomas and 776 early gastric cancers) in 1503 patients who had ESD between April 2005 and April 2010. Intervention: ESD. Main Outcome Measurements: Overt hematemesis/hematochezia, a drop of hemoglobin >2 g/dL from baseline, or requirement of endoscopic hemostasis, angiographic embolization, and/or transfusion. Results: Of 1591 subjects, 274 took antiplatelets, among whom 102 discontinued them for 7 days or more before ESD. Post-ESD bleeding occurred in 94 subjects including 20 from the continuation group, 6 from the withdrawal group, and 68 from the no-antiplatelet group. In univariate analysis, antiplatelets, early gastric cancer (EGG), comorbidity, and specimen diameter were related to post-ESD bleeding. In multivariate analysis, EGG (odds ratio [OR] 1.839; 95% confidence interval [CI] 1.168-2.896; P = .009), comorbidity (OR 2.246; 95% CI, 1.280-3.939; P = .005), and specimen diameter (OR 2.315; 95% CI, 1.282-4.180; P = .005) were independent risk factors of post-ESD bleeding, whereas antiplatelet usage was not (OR 1.596; 95% CI, 0.877-2.903; P = .126). In subgroup analysis, continuous antiplatelet usage was not found to be an independent risk factor of post-ESD bleeding in multivariate analysis (OR 2.027; P = .146). Among 102 subjects who discontinued antiplatelets, 1 developed an acute cerebral infarction (1.0%). Limitation: A retrospective, single-center analysis. Conclusion: In ESD for antiplatelet users, continuous administration was not found to have an independent significant association with bleeding. (Gastrointest Endosc 2012;75:719-27.)