Management of antithrombotic agents

After confirming with the prescribing physician whether treatment with antithrombotic agents could be interrupted or not, ESD was performed in accordance with the Japanese Gastroenterological Endoscopy Society guideline [20]. Heparin replacement was done for patients taking antithrombotic agents until December 2016 at the physician’s discretion in accordance with the guideline. Since January 2017, heparin replacement was ceased for all patients and ESD was performed after the prothrombin time international normalized ratio (PT-INR) was confirmed to be within the therapeutic range when warfarin administration was continued. DOACs were continued until the day prior to ESD and ceased on the morning of ESD. When treatment with antithrombotic agents was interrupted, antithrombotic therapy was restarted the day after ESD in the non-SLE group and after the confirmation of no post-ESD bleeding during SLE in the SLE group.

Based on a previous report, in this study, antithrombotic agent interruption was defined as the cessation of antithrombotic agents including temporary replacement of other antithrombotic agents by heparin, aspirin, or cilostazol [17].