No need for low-dose aspirin during ESD in patients with low thrombotic risk: study

A recent study has found no evidence of the noninferiority of low-dose aspirin (LDA) continuation over discontinuation during gastric endoscopic submucosal dissection (ESD) in patients with gastric mucosal neoplasms and low thrombotic risk.

Thus, LDA discontinuation during the periprocedural period is recommended in this population, according to the authors.

Overall, 551 patients were included in the study. The modified intent-to-treat analysis revealed a comparable incidence of ESD-related major bleeding (95 percent) between the LDA discontinuation and continuation groups (7.6 percent [n=276] vs 10 percent [n=275]; risk difference, 2.5 percent, 90 percent confidence interval [CI], ‒2.3 to 7.4).

The upper limit of the 2-sided 90-percent CI (6.6 percent) surpassed the predefined noninferiority margin (Δ5 percent; p=0.157). This negative result was also noted in the per-protocol analysis, with a risk difference of 4.4 percent (90 percent CI, ‒0.5 to 9.5).

Furthermore, two patients in the LDA continuation group developed cerebral infarction.

This study involved patients with gastric mucosal neoplasms and low thrombotic risk who were receiving LDA. Participants were randomized to either the continuation or discontinuation group. No prophylaxis was given, except for cauterizing exposed vessels at the ulcer base. The incidence of ESD-related major bleeding served as the primary endpoint.

“The recommendation to discontinue LDA during the periprocedural period of ESD for early gastric cancer remains controversial in patients at low thrombotic risk,” according to the authors. “If continuation of LDA does not increase bleeding risk, gastric ESD could be safely performed under sustained antiplatelet effects, benefiting patients.”