Effects of antithrombotic agents on post-operative bleeding after endoscopic resection of gastrointestinal neoplasms and polyps: A systematic review and meta-analysis

Table 2 Number of cases with or without antithrombotic agents and hemorrhagic outcome

Ref.	Resection method	Total	Drug	Post-bleeding	No bleeding
So et al[48], 2019	ER	1197	Antithrombotic agent (+/-)	40/50	359/748
			Continued antithrombotic agent (+/-)	11/7	69/138
			Discontinued antithrombotic agent (+/-)	29/43	330/657
			HR (+)	5	9
Kishida et al[45],2019	Polypectomy	6382	Antithrombotic agent (+/-)	15/40	986/5341
			Single APT (+)	4	683
			Single anticoagulants (+)	2	85
			Multiple APT (+)	3	163
			Multiple antithrombotic agents (+)	2	39
			Single antithrombotic agent (+)	13	947
			HR (+)	4	16
Inoue et al[65], 2019	EMR	102	VKA (+)	12	73
			Discontinued VKA (+)	0	4
			Continued VKA (+)	0	2
			HR (+)	15	98
			DOAC (+)	3	14
			Discontinued DOAC (+)	0	3
Inoue et al[65], 2019	ESD	54	VKA (+)	14	31
			Discontinued VKA (+)	1	2
			Continued VKA (+)	0	1
			HR (+)	13	31
			DOAC (+)	2	7
			Discontinued DOAC (+)	2	4
Harada et al[56], 2019	ESD	597	Antithrombotic agent (-)	21	422
			Single-LDA (+)	10	85
			DAPT (+)	10	49
			Continued LDA (+)	15	80
			Discontinued APT (+)	5	54
Arimoto et al[54], 2018	ESD	919	Antithrombotic agent (-)	26	757
			APT (+)	5	131
			Discontinued APT (+)	5	105
			Continued APT (+)	0	26
Azumi et al[39], 2018	ESD	438	Antithrombotic agent (+/-)	6/15	72/345
Fujita et al[67], 2018	EMR	84	Discontinued anticoagulants (+)	1	42
			HR (+)	4	37
Horikawa et al[58], 2018	ESD	100	Antithrombotic agent (-)	1	49
			Continued LDA	1	49
Izumikawa et al[40], 2018	ESD	273	Antithrombotic agent (+/-)	15/11	66/207
Kono et al[41], 2018	ESD	872	Antithrombotic agent (+/-)	23/38	159/652
			Single antithrombotic agent	12	130
			Multiple antithrombotic agents (+)	11	29
			Discontinued antithrombotic agent (+)	8	120
			Discontinued
			Single APT (+)	3	88
			Multiple APT (+)	3	16
			Single anticoagulants (+)	1	13
			Continued
			Single APT (+)	1	16
			Multiple APT (+)	4	2
			Single anticoagulants (+)	7	13
			HR (+)	10	21
Oh et al[60], 2018	ESD	215	Single APT (+)	14	147
			Multiple APT (+)	15	39
			LDA (+)	12	82
			Thienopyridine (+)	2	54
			Continued APT (+)	23	130
			Discontinued APT (+)	6	56
Park et al[63], 2018	Polypectomy	3887	APT (+)	12	339
			Anticoagulants (+)	0	15
Sanomura et al[58], 2018	ESD	1243	Antithrombotic agent (-)	40	1127
			Anticoagulants (+)	11	65
			Warfarin (+)	5	32
			DOAC (+)	4	14
Seo et al[55], 2018	ESD	1189	Antithrombotic agent (-)	26	945
			APT (+)	7	175
			Aspirin (+)	2	139
			Warfarin (+)	0	10
			DOAC (+)	1	2
			Single antithrombotic agent (+)	10	326
			Multiple antithrombotic agents (+)	0	23
			Discontinued antithrombotic agent (+)	7	206
			Continued antithrombotic agent (+)	0	5
Sakai et al[64], 2018	Polypectomy	1004	Discontinued anticoagulants (+)	12	0
			HR (+)	8	70
			Warfarin (+)	7	55
			DOAC (+)	1	15
Yamashita et al[36], 2018	ESD	650	Antithrombotic agent (+/-)	7/18	21/652
			Warfarin (+)	5	14
			DOAC	2	7
Yanagisawa et al[35], 2018	Polypectomy	436	Antithrombotic agent (+/-)	30/2	188/216
			Discontinued anticoagulants (+)	0	23
			Continued anticoagulants (+)	10	83
			HR (+)	20	82
			Continued warfarin (+)	2	41
			Continued DOAC (+)	8	42
			Warfarin (+)	20	125
			DOAC (+)	10	63
Matsumoto et al[46], 2018	Polypectomy	1003	Antithrombotic agent (+/-)	2/2	184/815
Harada et al[61], 2017	ESD	45	Continued warfarin (+)	2	20
			HR	5	18
Yano et al[33], 2017	ESD	144	Antithrombotic agent (+/-)	47/103	287/1330
Ueki et al[14], 2017	ESD	364	Antithrombotic agent (+/-)	7/17	67/273
			Discontinued antithrombotic agent (-)	7	67
			Discontinued single APT (+)	4	57
			Discontinued single anticoagulants (+/-)	2	4
			Aspirin (+)	4	43
			Thienopyrindine (+)	0	7
Yoshio et al[78], 2017	ESD	97	Warfarin (+)	18	55
			DOAC	5	19
Gotoda et al[15], 2017	ESD	529	Antithrombotic agent (+/-)	12/14	96/407
			APT (+)	8	80
			Single antithrombotic agent (+)	6	80
			Multiple antithrombotic agents (+)	7	17
			Single APT (+)	3	69
			Multiple APT (+)	5	11
			Warfarin (+)	3	11
			Aspirin (+)	2	33
			Thienopyridine (+)	0	10
Furuhata et al[17], 2017	ESD	1781	Antithrombotic agent (+/-)	33/68	220/1460
			Single antithrombotic agent (+)	11	139
			Multiple antithrombotic agents (+)	6	30
			Continued single APT (+)	1	14
			HR (+)	15	37
Shibuya et al[1], 2017	ESD	259	Antithrombotic agent (+/-)	4/6	32/217
Shibuya et al[1], 2017	EMR	3018	Antithrombotic agent (+/-)	16/15	510/2477
Shibuya et al[1], 2017	Polypectomy	892	Antithrombotic agent (+/-)	3/5	163/721
Bronsgeest et al[42], 2017	EMR		Antithrombotic agent (+/-)	13/15	107/277
			APT (+)	4	53
			Anticoagulants (+)	4	43
Ishigami et al[34], 2017	ER	773	Antithrombotic agent (+/-)	10/14	35/714
			HR (+)	10	35
Pigò et al[3], 2017	Polypectomy	609	Antithrombotic agent (+/-)	38/32	72/467
			Single APT	14	57
			Multiple APT	3	8
			HR (+)	21	7
			Aspirin (+)	10	32
			Thienopyridine	4	25
Kono et al[76], 2017	ESD/EMR	49	Single antithrombotic agent (+)	4	24
			Multiple antithrombotic agents (+)	7	14
			Discontinued antithrombotic agent (+)	5	20
			Continued antithrombotic agent (+)	6	18
			HR (+)	4	12
Lin et al[75], 2017	Polypectomy	4923	Aspirin (+)	36	3897
			Thienopyridine (+)	5	590
Sato et al[38], 2017	ESD	2378	Antithrombotic agent (+/-)	46/76	401/1855
			APT (+)	35	270
			Anticoagulants (+)	2	33
			HR (+)	6	33
			Aspirin (+)	12	199
			Thienopyridine (+)	0	19
			Warfarin (+)	1	16
			DOAC (+)	1	17
Igarashi et al[27], 2017	ESD	976	Antithrombotic agent (+/-)	35/30	332/692
			Discontinued antithrombotic agent (+)	26	250
			Continued antithrombotic agent (+)	5	49
			HR	4	33
			Multiple antithrombotic agents (+)	9	70
			Single antithrombotic agent (+)	26	262
			Continued aspirin (+)	4	29
			Discontinue aspirin (+)	19	152
			Continued thienopyridine (+)	1	17
			Discontinued thienopyridine (+)	9	63
			Continued anticoagulants (+)	1	11
			Discontinued anticoagulants (+)	3	27
Amato et al[31], 2016	ER	2692	Antithrombotic agent (+/-)	16/16	595/2069
			APT (+)	11	461
			Anticoagulants (+)	5	134
Kubo et al[32], 2016	ER	788	Antithrombotic agent (+/-)	16/13	194/565
			APT (+)	8	146
			Anticoagulants (+)	11	72
			HR (+)	10	63
Shindo et al[25], 2016	ESD	262	Antithrombotic agent (+/-)	10/13	38/201
			Discontinued antithrombotic agent (+)	0	25
			Continued APT (+)	2	8
			HR (+)	8	5
Yoshida et al[52], 2016	ESD	678	Antithrombotic agent (-)	10	585
			APT (+)	3	60
			Anticoagulants (+)	3	17
Ninomiya et al[53], 2015	ESD	609	Antithrombotic agent (-)	28	537
			Discontinued APT (+)	2	11
			Continued APT (+)	5	26
Al-Mammari et al[4], 2015	EMR	117	Antithrombotic agent (+/-)	1/1	14/101
Odagiri et al[16], 2015	ESD	7567	Antithrombotic agent (+/-)	49/282	440/6796
Namasivayam et al[5],2014	EMR	1712	Antithrombotic agent (+/-)	4/10	772/912
			APT (+)	3	521
			Anticoagulants (+)	0	89
			Single antithrombotic agent (+)	1	617
			Multiple antithrombotic agents (+)	3	111
			Thienopyridine (+/-)	0/10	17/912
Terasaki et al[21], 2014	ESD	363	Antithrombotic agent (+/-)	4/20	36/303
Tounou et al[50], 2014	ESD	350	Antithrombotic agent (-)	16	245
			Discontinued single APT (+)	7	37
			Continued single APT (+)	2	12
			Dual APT (+)	11	20
			Aspirin (+)	9	44
			Thienopyridine (+)	0	5
Suzuki et al[18], 2014	ESD	317	Antithrombotic agent (+/-)	1/13	27/276
			HR	0	6
Matsumura et al[23], 2014	ESD	425	Antithrombotic agent (+/-)	10/10	77/328
			Discontinued antithrombotic agent (+)	2	39
			Continued antithrombotic agent (+), HR (-)	3	22
			HR (+)	5	16
Beppu et al[74], 2014	ER	208	APT (+)	9	18
			Anticoagulants (+)	12	9
			Aspirin (+)	6	11
			Thienopyridine (+)	3	7
Inoue et al[77], 2014	Polypectomy	117	Discontinued antithrombotic agent (+)	1	71
			HR (+)	9	36
Sanomura et al[66], 2014	ESD	78	Continued LDA (+)	1	27
			Discontinued LDA (+)	3	63
Yoshio et al[47], 2013	ESD	1250	Antithrombotic agent (-)	45	972
			Discontinued antithrombotic agent (-)	12	197
			HR (+)	9	15
Takeuchi et al[29], 2013	ESD	833	Antithrombotic agent (+/-)	21/15	69/728
Koh et al[37], 2013	ESD	1166	Antithrombotic agent (+/-)	17/45	158/946
Mukai et al[6], 2012	ESD	161	Antithrombotic agent (+/-)	4/17	29/111
Lim et al[51], 2012	ESD	1591	Antithrombotic agent (-)	68	1249
			Discontinued APT (+)	6	96
			Continued APT (+)	20	152
Miyahara et al[48], 2012	ESD	1082	Antithrombotic agent (-)	68	883
			Discontinued antithrombotic agent (+)	7	124
Cho et al[57], 2012	ESD	514	Antithrombotic agent (-)	15	424
			Discontinued APT (+)	2	54
			Continued APT (+)	4	15
Toyokawa et al[24], 2011	ESD	1123	Antithrombotic agent (+/-)	8/48	175/892
Higashiyama et al[19], 2011	ESD	924	Antithrombotic agent (+/-)	123/773	3/25
Metz et al[2], 2011	EMR	269	Antithrombotic agent (+/-)	8/11	30/220
			APT (+)	6	18
			Anticoagulants (+)	1	10
			HR (+)	1	2
			Aspirin (+)	5	12
			Thienopyridine (+)	1	6
Tokioka et al[30], 2011	ESD	515	Antithrombotic agent (+/-)	3/23	37/452
Okada et al[22], 2011	ESD	582	Antithrombotic agent (+/-)	4/24	70/484
Mannen et al[20], 2010	ESD	436	Antithrombotic agent (+/-)	1/38	32/365
Goto et al[13],2010	ESD	454	Antithrombotic agent (+/-)	5/21	52/376
Witt et al[44], 2009	Polypectomy	1225	Antithrombotic agent (+/-)	11/2	414/798
Ono et al[28], 2019	ESD	444	Antithrombotic agent (+/-)	6/20	50/368
Takizawa et al[26], 2008	ESD	968	Antithrombotic agent (+/-)	3/60	74/831
Sawhney et al[62], 2007	Polypectomy	173	APT (+)	17	51
			Anticoagulants (+)	14	12
Yousfi et al[43], 2004	Polypectomy	162	Antithrombotic agent (+/-)	32/49	27/54
			APT (+)	32	27

ER: Endoscopic resection; ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection; APT: Antiplatelet; LDA: Low dose of aspirin; HR: Heparin replacement; DOAC: Direct oral anticoagulant; Thienopyridine: Thienopyridine derivatives.