Optimal Timing of Resuming Anticoagulant After Colorectal Endoscopic Submucosal Dissection

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Abstract
Background and Aim: Delayed bleeding after colorectal ESD is a significant adverse event, particularly in patients receiving anticoagulants. However, the optimal timing for resuming anticoagulant therapy remains unclear. This study aimed to determine the optimal timing for resuming anticoagulants after colorectal ESD. Methods: We retrospectively analyzed data from 1309 colorectal ESD cases including 957 on direct oral anticoagulants (DOACs) and 365 on warfarin from the ABCD‐J study, which included 34 450 colorectal ESD cases across 47 Japanese institutions. Patients were categorized into two groups based on the timing of anticoagulant resumption: early (resumption within 1 day post‐ESD) and late (resumption two or more days post‐ESD). After propensity score matching, delayed bleeding, delayed perforation, and thromboembolic events were compared between groups. Results: Overall, 334 matched cases were analyzed in the early and late groups. There was no significant difference in the overall delayed bleeding rate between the two groups (9.6% vs. 6.6%, p = 0.201). In the entire cohort, before resumption, the bleeding rate was significantly lower in the early group (1.18% vs. 3.23%, p = 0.013). Conversely, after resumption, it was significantly higher in the early group (9.42% vs. 6.02%, p = 0.041). Additionally, there was no significant difference in thromboembolic event rates between the groups (0% vs. 0%, p = 1.000). Subgroup analyses showed no significant difference in delayed bleeding rates within the matched groups for DOAC (210 cases; 9.0% vs. 6.2%, p = 0.358) or warfarin (105 cases; 11.4% vs. 6.7%, p = 0.336). Conclusions: The early resumption of anticoagulants within 1 day post‐ESD did not significantly increase delayed bleeding.

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