Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Oct 28, 2020; 8(5): 411-434
Published online Oct 28, 2020. doi: 10.13105/wjma.v8.i5.411
Effects of antithrombotic agents on post-operative bleeding after endoscopic resection of gastrointestinal neoplasms and polyps: A systematic review and meta-analysis
Bing-Jie Xiang, Yu-Hong Huang, Min Jiang, Cong Dai
Bing-Jie Xiang, Yu-Hong Huang, Min Jiang, Cong Dai, Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Xiang BJ had the original idea for the paper, formulated the protocol; Xiang BJ and Huang YH carried out the literature search, selection, validity assessment, data abstraction and data analysis; Xiang BJ and Dai C wrote the paper and incorporated the comments from other authors; and all authors reviewed and approved the final draft of the paper. 
Supported by Liaoning Science and Technology Foundation, No. 20170541052.
Conflict-of-interest statement: No conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cong Dai, PhD, Assistant Professor, Department of Gastroenterology, First Affiliated Hospital, China Medical University, No. 92 Beier Road, Heping District, Shenyang 110001, Liaoning Province, China. congdai2006@sohu.com
Received: September 17, 2020
Peer-review started: September 18, 2020
First decision: September 29, 2020
Revised: October 7, 2020
Accepted: October 27, 2020
Article in press: October 27, 2020
Published online: October 28, 2020
Processing time: 40 Days and 22.7 Hours
Abstract
BACKGROUND

There are some studies investigating the relationship between antithrombotic medication and postoperative bleeding after endoscopic resection (ER) with controversial results. 

AIM

To perform a meta-analysis evaluating the effects of antithrombotic therapy on postoperative bleeding after ER.

METHODS

A systematic search was conducted on PubMed, Web of Science, Cochrane Library. The Newcastle-Ottawa scale was used to evaluate the quality of studies. Stata 12.0 was used for statistical analysis. The odds ratio (OR) and 95%CI were calculated and heterogeneity was quantified using Cochran’s Q test and I2.

RESULTS

Total 66 studies were included in the meta-analysis. Pooled data suggested that antithrombotic therapy was significantly associated with postoperative bleeding (OR = 2.302, 95%CI: 2.057-2.577, P = 0.000) after ER. The risk of postoperative bleeding after endoscopic submucosal dissection, endoscopic mucosal resection and polypectomy in the antithrombotic group was higher than the non-antithrombotic group (OR = 2.439, 95%CI: 1.916-3.105; OR = 2.688, 95%CI: 1.098-6.582; OR = 2.112, 95%CI: 1.434-3.112). 

CONCLUSION

The risk of postoperative bleeding after ER correlated with the types and management of antithrombotic agents by our meta-analysis.

Keywords: Endoscopic resection; Antithrombotic; Anticoagulants; Postoperative bleeding; Endoscopic mucosal resection; Endoscopic submucosal dissection

Core Tip: In recent years, more and more people suffering from cardiovascular disease and/or cerebrovascular disease receive antithrombotic therapy which change patients’ coagulation status and may lead to high risk of postoperative bleeding after endoscopic resection (ER). The relationship between the postoperative bleeding after ER and antithrombotic agents is still uncertain. With this reason, a systematic review and meta-analysis was carried out to identify whether the use of antithrombotic drugs increases the risk of the postoperative bleeding after ER.