Abstract
Background and objective:
Current guidelines recommend aspirin maintenance therapy for high-risk endoscopic procedures. However, some Asian physicians noticed an increase of postoperative bleeding in patients taking aspirin. We aimed to explore whether the risk of postoperative hemorrhage due to aspirin differs in the East and the West.
Methods:
PubMed, EMBASE and Cochrane library database were systematically reviewed. Relevant references were checked for additional data. We only included trials that met our criteria.
Results:
There is a significant association between aspirin and postoperative bleeding (P<0.001), especially in Eastern population (data from Japan, Korea, Turkey and China, P<0.001). However, the result from the West (data from America, Canada and Australia) had no statistical significance (P=0.07). For Eastern patients, aspirin could increase the risk of bleeding after endoscopic submucosal dissection (ESD) and endoscopic sphincterotomy (EST). For Western patients, aspirin increased the risk of bleeding post endoscopic mucosal resection (EMR). When it comes to withdrawal time, for patients who underwent ESD, those who continued to receive aspirin had a much higher bleeding risk than patients who interrupted it for more than 7 days (P=0.005).
Conclusion:
Aspirin could increase the risk of postoperative hemorrhage after high-risk endoscopic operations. Easterners are more likely to suffer from bleeding after aspirin administration than Westerners. Stopping aspirin for more than 7 days may be advisable to control bleeding post ESD for patients with low risk of thrombosis.
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