Risk factors for postoperative bleeding after gastric endoscopic submucosal dissection in patients under antithrombotics

Table 1 Overall clinicopathological profiles of 262 gastric neoplasms in 250 patients

Patients background factors
Age (yr, mean ± SD) (range)	71 ± 8 (32-87)
Sex (male/female)	190/72
Antithrombotic agent user	48 (18.3%)
Detail
Aspirin	28
Clopidogrel	6
Ticlopidine	1
Cilostazol	4
Warfarin	14
Heparin replacement (withdrawal warfarin)	13
Hemodialysis	6 (2.3%)
Hypertension	130 (49.6%)
Diabetes mellitus	54 (20.6%)
Cardiovascular disease	48 (18.3%)
Resected lesion factors
Curability (curative/expanding indications curative/non-curative)	175/57/30
Macroscopic type (depressed/flat/protruded)	151/101/10
Location (upper third/middle third/lower third)	38/73/151
Circumference (anterior wall, greater curvature, lesser curvature, posterior wall)	38/52/124/48
Tumor size (mm, mean ± SD) (range)	15.9 ± 10.9 (2-85)
Differentiation (adenoma/differentiated cancer/undifferentiated cancer)	34/216/12
Depth (M:SM1:SM2)	236/12/14
Ulcer findings positive	16 (6.1%)
Lymphovascular infiltration positive	18 (6.9%)
Horizontal or vertical margin positive	8 (3.1%)
Perioperative factors
En bloc resection	259 (98.8%)
Operator (beginner/expert)	97/165
Operation time (min, mean ± SD) (range)	81.5 ± 50.9 (16-307)
Resected size (mm, mean ± SD) (range)	36.1 ± 11.6 (12-88)
Perforation	2 (0.8%)
Postoperative bleeding	23 (8.8%)
Blood transfusion (%)	7 (2.7%)

SM: Submucosal layer.

Table 2 Univariate analysis of postoperative bleeding

	Present (n = 23)	Absent (n = 239)	P value
Patients background factors
Age (yr, mean ± SD) (range)	73 ± 7 (58-82)	71 ± 8 (32-87)	0.4304
Sex (male/female)	7/16	174/65	0.7397
Antithrombotic agent user	10 (43.5%)	38 (15.9%)	0.00111
Category of antithrombotic treatment (non-antithrombotic therapy/discontinuation of antithrombotic agents/continuation of antiplatelet agents/heparin replacement)	13/0/2/8	201/25/8/5	< 0.00011
Hemodialysis	2 (8.7%)	4 (1.7%)	0.03211
Hypertension	10 (43.5%)	120 (50.2%)	0.5375
Diabetes mellitus	1 (4.3%)	53 (22.1%)	0.04351
Cardiovascular disease	9 (39.1%)	39 (16.3%)	0.00691
PT-INR (mean ± SD) (range)	1.2 ± 0.5 (0.9-2.1)	0.9 ± 0.1 (0.9-2.0)	< 0.00011
Charlson comorbidity index (mean ± SD) (range)	3.5 ± 1.2 (1-6)	3.2 ± 1.3 (0-8)	0.2674
Hemoglobin levels on admission (g/dL, mean ± SD) (range)	12.5 ± 1.3 (9.6-14.4)	13.3 ± 1.5 (7.8-17.1)	0.01531
Resected lesion factors
Curability (curative/expanding indications curative/non-curative)	19/3/1	156/54/29	0.2305
Macroscopic type (depressed/flat/protruded)	11/11/1	140/90/9	0.6058
Location (upper third/middle third/lower third)	2/3/18	36/70/133	0.0907
Circumference (anterior wall, greater curvature, lesser curvature, posterior wall)	3/4/11/5	35/48/113/43	0.9645
Tumor size (≥ 21 mm)	3 (13.0%)	51 (21.3%)	0.3476
Differentiation (adenoma/differentiated cancer/undifferentiated cancer)	3/2/18	31/198/10	0.6108
Depth (M:SM1:SM2)	22/0/1	214/12/13	0.525
Ulcer findings positive	0 (0%)	16 (6.7%)	0.2003
Lymphovascular infiltration positive	1 (4.3%)	17 (7.1%)	0.6166
Horizontal or vertical margin positive	1 (4.3%)	7 (2.9%)	0.7204
Tumor size (mm, mean ± SD)	17.3 ± 16.1 (6-85)	15.7 ± 10.3 (2-70)	0.5147
Perioperative factors
Operator (beginner/expert)	9/14	88/151	0.8265
Resected size (mm, mean ± SD) (range)	38.9 ± 12.8 (25-88)	35.8 ± 11.5 (12-85)	0.5147
Perforation (%)	1 (4.3%)	1 (0.4%)	0.1286
Operation time (min, mean ± SD) (range)	87.4 ± 63.5 (31-260)	80.9 ± 49.6 (16-307)	0.5608

¹Significantly different. SM: Submucosal layer; PT-INR: Prothrombin time-international normalized ratio.

Table 3 Multivariate analysis of postoperative bleeding

Risk factors	Odds ratio	95%CI	P value
Cardiovascular disease	1.1	0.09-13.2	0.931
Diabetes mellitus	0.2	0.02-1.8	0.156
Hemodialysis	3.3	0.17-65.1	0.434
Heparin replacement	13.7	1.2-151.3	0.0331
Location lower third	2.9	0.9-8.9	0.07

¹Significantly different.