Original articleClinical endoscopyRisk factors for postpolypectomy bleeding in patients receiving anticoagulation or antiplatelet medications
Section snippets
Study design
The study was conducted at 2 VA hospitals with similar endoscopic practices, VA Palo Alto and VA San Francisco. All procedures were performed or supervised by 1 of 24 staff endoscopists from January 2004 to June 2012. The study was conducted in 2 parts. The first was a retrospective cohort study to assess the primary endpoint and the incidence of postpolypectomy bleeding on various antithrombotics. The second was a matched case control study to examine the secondary endpoint, risk factors for
Bleeding incidence
We identified 20,374 cases with polypectomy. Approximately a quarter of these patients were on warfarin, low molecular weight heparin, clopidogrel, or aspirin. Among cases on antithrombotics, 12.5% were on warfarin.
We found a significantly higher rate of postpolypectomy bleeding in patients on anticoagulation bridge therapy at 14.9% (13/87) (95% CI, 8.20%-24.4%). This was in comparison to patients taking antithrombotics at 1.19% (59/4923) (95% CI, 0.91%-1.54%) (Table 1). The bleeding incidence
Discussion
We found that the risk of postpolypectomy bleeding in patients on bridge anticoagulation was significantly higher than that of patients on warfarin alone. Moreover, this was an independent risk factor for postpolypectomy bleeding, conferring a 10-fold higher risk of bleeding. We demonstrated that the incidence of bleeding for patients on bridge anticoagulation approached 1 in 7 patients undergoing polypectomy. This is in stark contrast to the overall low incidence of postpolypectomy bleeding in
Acknowledgments
The authors thank Kristin Frazier for helping to obtain the request for database query.
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Cited by (25)
Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon
2024, Gastrointestinal Endoscopy Clinics of North AmericaPostpolypectomy bleeding of colorectal polyps in patients with continuous warfarin and short-term interruption of direct oral anticoagulants
2021, Gastrointestinal EndoscopyCitation Excerpt :Prophylactic clipping was performed at the endoscopist’s discretion. PPB was defined as hematochezia requiring endoscopic hemostasis with apparent bleeding from the resection site within 30 days after the procedure.11 Emergent colonoscopy was performed if PPB was suspected.
Antiplatelet and/or anticoagulant treatment does not increase hemorrhagic adverse events during EUS-guided biliary drainage
2020, Gastrointestinal EndoscopyAnticoagulation or antiplatelet medications and postpolypectomy bleeding
2019, Gastrointestinal EndoscopyPatients Prescribed Direct-Acting Oral Anticoagulants Have Low Risk of Postpolypectomy Complications
2019, Clinical Gastroenterology and HepatologyCitation Excerpt :More recent studies have suggested DOACs may have a lower risk of postpolypectomy bleeding compared with warfarin,11,17,18 in line with our study findings. Similarly, clopidogrel use has also been associated with an increased risk of postpolypectomy bleeding.19, 20 Our analyzed cohort is one of the largest studied antithrombotic groups who underwent colonoscopy with polypectomy and includes both men and women with a mean age of 61.2 ± 10.7 years and a mean CCI, of 0.87 ± 1.34.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
See CME section: p. 1121.
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