The Japan Gastroenterological Endoscopy Society (JGES) guidelines recommend continued
warfarin treatment during gastroenterological endoscopic procedures with a high risk of
bleeding as an alternative to
heparin replacement in patients on
warfarin therapy. However, there is insufficient evidence to support the use of
warfarin in colorectal endoscopic resection (ER). The present study is aimed at verifying the risk of
bleeding after ER for colorectal
neoplasia (CRN) in patients with continued
warfarin use. This was a single-center retrospective cohort study using clinical records. We assessed 126 consecutive patients with 159 CRNs who underwent ER (endoscopic mucosal resection, 146 cases; endoscopic submucosal dissection, 13 cases) at Hiroshima University Hospital between January 2014 and December 2019. Patients were divided into two groups: the
heparin replacement group (79 patients with 79 CRNs) and the continued
warfarin group (47 patients with 80 CRNs). One-to-one propensity score matching was performed to compare the
bleeding rate after ER between the groups. The rate of
bleeding after ER was significantly higher in the
heparin replacement group than in the continued
warfarin group for both before (10.1% vs. 1.3%, respectively; P = 0.0178) and after (11.9% vs. 0%, respectively; P = 0.0211) propensity score matching. None of the patients experienced thromboembolic events during the
perioperative period. The risk of
bleeding after colorectal ER was significantly lower in patients with continued
warfarin use than in those with
heparin replacement. Our data supports the recommendations of the latest JGES guidelines for patients receiving
warfarin therapy.