{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:12:13Z","timestamp":1787015533587,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>The 2017 Japanese guidelines recommend continuing warfarin therapy during the perioperative period or discontinuing direct oral anticoagulants (DOACs) only on the day of endoscopic submucosal dissection for early gastric cancer. However, their safety has not been sufficiently explored. This study aimed to validate this management method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, multicenter study analyzed the characteristics and outcomes of patients who underwent gastric endoscopic submucosal dissection between July 2017 and June 2019. The patients were categorized according to the use of warfarin or DOACs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 62 eligible patients, 53 (85%) were male (median age, 76\u00a0years). Warfarin was used in 10 patients (16%) and DOACs in 52 patients (84%). Fourteen patients taking DOACs (27%) used concomitant antiplatelet agents, with seven patients (13%) continuing treatment at the time of the endoscopic procedure. No postprocedural bleeding occurred in patients receiving warfarin (0%), whereas 10 cases (19%) of bleeding occurred in patients receiving DOACs: rivaroxaban, 0% (0\/22); dabigatran, 0% (0\/2); edoxaban, 43% (6\/14); and apixaban, 29% (4\/14). The type of anticoagulant (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.01) and continuation of antiplatelet therapy (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.02) were risk factors for postprocedural bleeding in patients receiving DOACs. Intraprocedural bleeding requiring transfusion or symptomatic thromboembolic events were not reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Continuous warfarin therapy is preferred. DOAC withdrawal 1\u00a0day before a procedure is associated with a high bleeding rate, which may differ for different types of anticoagulants. The continuation of antiplatelet medications in patients receiving DOACs carries a high risk of bleeding and is a future challenge.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgh.16757","type":"journal-article","created":{"date-parts":[[2024,10,4]],"date-time":"2024-10-04T00:13:24Z","timestamp":1728000804000},"page":"2760-2766","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Rates and risk factors of bleeding after gastric endoscopic submucosal dissection with continuous warfarin or 1\u2010day withdrawal of direct oral anticoagulants"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7814-9353","authenticated-orcid":false,"given":"Shoichiro","family":"Hirata","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenta","family":"Hamada","sequence":"additional","affiliation":[{"name":"Department of Practical Gastrointestinal Endoscopy Okayama University  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1757-5754","authenticated-orcid":false,"given":"Masaya","family":"Iwamuro","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Mouri","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Kurashiki Central Hospital  Kurashiki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Miyahara","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Hiroshima City Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Tsuzuki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Japanese Red Cross Society Himeji Hospital  Himeji Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Yamauchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Mitoyo General Hospital  Kanonji Japan"},{"name":"Department of Gastroenterology Kagawa Prefectural Central Hospital  Takamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayo","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Fukuyama City Hospital  Fukuyama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakuma","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Kagawa Prefectural Central Hospital  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