Risk factors and prediction of bleeding after gastric endoscopic submucosal dissection in patients on antithrombotic therapy: newly developed bleeding prediction application software, SAMURAI model

Akitoshi Hakoda, Toshihisa Takeuchi, Yuichi Kojima, Yasuhiro Fujiwara, Yasuaki Nagami, Yuji Naito, Shinsaku Fukuda, Tomoyuki Koike, Mitsushige Sugimoto, Kenta Hamada, Hideki Kobara, Norimasa Yoshida, Tomoki Inaba, Akihito Nagahara, Eriko Koizumi, Kazunari Murakami, Takahisa Furuta, Naotaka Ogasawara, Hajime Isomoto, Kotaro ShibagakiHiromi Kataoka, Hidekazu Suzuki, Kazuhide Higuchi

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Bleeding after gastric endoscopic submucosal dissection (ESD) remains problematic, especially in patients receiving antithrombotic therapy. Therefore, this study aimed to identify the risk factors. In this retrospective study, patients (n = 1,207) who underwent gastric ESD while receiving antithrombotic therapy were enrolled at Osaka Medical and Pharmaceutical University Hospital and 18 other referral hospitals in Japan. Risks of post-ESD bleeding were calculated using multivariable logistic regression. The dataset was divided into a derivation cohort and a validation cohort. We created a prediction model using the derivation cohort. The accuracy of the model was evaluated using the validation cohort. Post-ESD bleeding occurred in 142 (11.8%) participants. Multivariable analysis yielded an odds ratio of 2.33 for aspirin, 4.90 for P2Y12 receptor antagonist, 1.79 for cilostazol, 0.95 for other antithrombotic agents, 6.53 for warfarin, 5.65 for dabigatran, 7.84 for apixaban, 10.45 for edoxaban, 6.02 for rivaroxaban, and 1.46 for heparin bridging. The created prediction model was called safe ESD management using the risk analysis of post-bleeding in patients with antithrombotic therapy (SAMURAI). This model had good predictability, with a C-statistic of 0.77. In conclusion, use of the SAMURAI model will allow proactive management of post-ESD bleeding risk in patients receiving antithrombotic therapy.

Original languageEnglish
Pages (from-to)189-196
Number of pages8
Journaljournal of clinical biochemistry and nutrition
Volume70
Issue number2
DOIs
Publication statusPublished - 2022

Keywords

  • antithrombotic agents
  • bleeding
  • multivariable analysis
  • prediction model
  • validation

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Clinical Biochemistry

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