Anticoagulation and antiplatelet management in gastrointestinal endoscopy: A review of current evidence

Table 53 Endoscopic mucosal resection

Ref.	Year	Country	Study design	n	Polyp morphology	Procedure	Medication	Relative risk
Fujita et al[135]	2018	Japan	Prospective (non-HBT group) and retrospective (HBT group)	84	Size < 10mm (mean size 7.2-7.8 ± 2.2-3.2 mm	EMR	DOAC ± HBT (ceased morning of)	Incidence of PBB 2.3% (non-HBT). No incidence of PPB (HBT)
Ono et al[113]	2019	Japan	Retrospective	825	Size median size 8.5-9.5 ± 5 mm between groups	EMR	DOACs (ceased day of)	Incidence of PPB 6.5%
So et al[50]	2019	South Korea	Retrospective	399 (1197)	Size mean lesion 34 mm	EMR and ESD	DOAC (ceased day of procedure or 0-4 d before or ceased 5-7 d before or ceased 8-14 d before procedure)	Incidence of PPB 16.7% (anticoagulant group) (study did not specify the risk comparing warfarin and DOAC individually)
Albénizet al[114]	2020	Spain	Prospective	977	Size ≥ 20mm (mean size 30.5 mm)	EMR	DOAC (ceased 48-72 h before)	Expressed as OR (OR: 4.54, 95%CI: 2.14-9.63, P < 0.001) (anticoagulant use) (specific PPB rates between warfarin and DOACs not specified)

EMR: Endoscopic mucosal resection; DOAC: Direct oral anticoagulant; ESD: Endoscopic submucosal dissection; HBT: Heparin bridging therapy; OR: Odds ratio; PPB: Post-procedural bleeding.