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Figure 1 | BMC Gastroenterology

Figure 1

From: The postoperative bleeding rate and its risk factors in patients on antithrombotic therapy who undergo gastric endoscopic submucosal dissection

Figure 1

Endoscopic submucosal dissection protocol. For all patients, the day of the ESD procedure was set as Day 1. Patients were fasted until Day 2 and allowed to eat from Day 3. After resumption of oral feeding on Day 3, patients were commenced on an oral PPI. Patients regularly taking mucosal protective agents prior to undergoing ESD were asked to discontinue them on Days 1 and 2 and recommence them on Day 3. The protocol for antiplatelet agents was to discontinue them from Day −6 to Day 2, and that for anticoagulants was to discontinue them from Day −4 to Day 2. Heparin was substituted for anticoagulants while the latter were discontinued, maintaining the APTT at roughly twice the preheparinization level. Antiplatelet agents were recommenced as soon as possible on postoperative Day 3, following confirmation of hemostasis by EGD on Day 2. Anticoagulants were similarly recommenced on postoperative Day 3, and heparin was discontinued once the PT-INR had returned to a therapeutic level.

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