Thinking Outside the BoxColonoscopy with polypectomy in anticoagulated patients
Section snippets
Methods
We retrospectively reviewed our experience from July 2004 to August 2005 in performing colonoscopy with polypectomy in patients receiving long-term anticoagulation therapy at the Veterans Affairs Palo Alto Health Care System. Informed consent for the procedure was obtained from all patients, including discussion of the potentially high risk of bleeding as a result of anticoagulation. Institutional Review Board approval was obtained for retrospective data analysis. All patients undergoing
Results
Twenty-one patients underwent a total of 41 colonoscopic polypectomies during the study period. The average INR on the day of the procedure was 2.3 (SD 0.8, range 1.4-4.9, median 2.0; normal 0.9-1.2). The average polyp size was 5.0 mm (SD 1.5 mm, range 3-10 mm). Immediately after polypectomy, 1 or 2 endoclips were placed prophylactically to close the polypectomy defect. Because this was typically done within 1 minute of the polypectomy, no more than minimal (<10 mL) bleeding occurred in any of
Discussion
Postpolypectomy bleeding is generally divided into 2 types: immediate bleeding after the polypectomy and delayed bleeding that can occur up to 2 to 3 weeks after the procedure.8, 9 Immediate bleeding is particularly common after endoscopic mucosal resection of large sessile polyps, and it is generally effectively treated by expert endoscopists using established techniques such as clipping.10, 11 In patients who require long-term anticoagulation, all the published guidelines recommend temporary
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