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World J Gastroenterol. May 21, 2023; 29(19): 2916-2931
Published online May 21, 2023. doi: 10.3748/wjg.v29.i19.2916
Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants
Mitsushige Sugimoto, Masaki Murata, Takashi Kawai
Mitsushige Sugimoto, Takashi Kawai, Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
Masaki Murata, Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
Author contributions: Sugimoto M wrote the paper; Sugimoto M, Murata M and Kawai T collected the data.
Supported by the Grant-in-Aid for Scientific Research in Japan, No. 21K07949.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mitsushige Sugimoto, AGAF, MD, PhD, Professor, Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. sugimo@tokyo-med.ac.jp
Received: January 24, 2023
Peer-review started: January 24, 2023
First decision: March 21, 2023
Revised: April 3, 2023
Accepted: April 24, 2023
Article in press: April 24, 2023
Published online: May 21, 2023
Core Tip

Core Tip: Recent international clinical guidelines for early-stage gastrointestinal tumors recommend endoscopic submucosal dissection (ESD) as the first-line treatment. Direct oral anticoagulants (DOACs) are a major risk factor for post-ESD bleeding and the pharmacokinetics and pharmacodynamics of DOACs may be related to risk of post-ESD bleeding. Therefore, one way to monitor the anticoagulant effect of DOACs in clinical practice may be to develop a system that effectively measures anti–FXa activity and plasma concentration. In the future, it may be useful to stratify risk of post-ESD delayed bleeding based on a scoring system that includes pharmacological parameters of DOACs.