Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants

Table 4 Summary of international guidelines concerning withdrawal of direct oral anticoagulants during gastroenterological endoscopy

Ref.	Country	Standard endoscopy	Biopsy	Low risk of bleeding	High risk of bleeding, including ESD
[71]	Japan	1	2Avoid peak plasma level	2Avoid peak plasma level	3(1) Withdraw on the day of treatment; and (2) Heparin replacement
[72]	Europe	1	3Withdraw on the day of treatment	3Withdraw on the day of treatment	3(1) Withdraw 3 d before treatment; (2) Withdraw 5 d before treatment for dabigatran patients at Ccr 30–50 mL/min; and (3) No heparin bridging
[73]	United States	1	1	1	3(1) Withdraw; and (2) Bridge therapy required for patients at high risk for thromboembolic events
[74]	Korea	1	1	1	3Withdraw 2 d before treatment
[75]	Asia-Pacific	1	1	1	3Withdraw 2 d before treatment

¹Withdrawal is not required.

²Withdrawal is not required but possible.

³Withdrawal is required.

ESD: Endoscopic submucosal dissection; Ccr: Creatinine clearance.