Meta‐analysis: colonoscopic post‐polypectomy bleeding in patients on continued clopidogrel therapy

Gandhi, Sumeet; Narula, Neeraj; Mosleh, Wassim; Marshall, John K.; Farkouh, Michael E.

doi:10.1111/apt.12292

Cited by 59 publications

(33 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Manocha et al[25] demonstrated PPB rates of patients on aspirin and NSAIDs vs those not on aspirin or NSAIDs (3.2% vs 3.0%). In contrast, polypectomy on clopidogrel is likely to have increased risk for PPB[8]. It might be prudent to postpone polypectomy for high thrombotic risk patients taking clopidogrel.…”

Section: Discussionmentioning

confidence: 99%

Heparin bridge therapy and post-polypectomy bleeding

Kubo

Yamashita

Onodera

et al. 2016

WJG

View full text Add to dashboard Cite

AIMTo identify risk factors for post-polypectomy bleeding (PPB), focusing on antithrombotic agents.METHODSThis was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed.RESULTSPPB occurred in 29 (3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210 (26.6%) patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB (P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB (P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant.CONCLUSIONPatients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.

show abstract

Section: Discussionmentioning

confidence: 99%

Heparin bridge therapy and post-polypectomy bleeding

Kubo

Yamashita

Onodera

et al. 2016

WJG

View full text Add to dashboard Cite

show abstract

“…120 Polyp size was less than 10 mm in 88% of the cases, and the proportion of patients on DAPT ranged from 54% to 87.8%. [121][122][123] There was an overall increased risk of PPB (RR, 2.54; 95% CI 1.68 to 3.84) and of delayed PPB (RR, 4.66; 95% CI 2.37 to 9.17).…”

Section: Polypectomy On Antithrombotic Therapymentioning

confidence: 92%

“…Another meta-analysis that included five studies demonstrated an increased risk of delayed but not immediate PPB on clopidogrel. 120 A prospective study including 823 patients focused on cold polypectomy (using forceps or snare method) with a mean polyp size of 4.7±1.3 mm 91 ; 15% of the patients were taking low dose aspirin or ticlopidine. The risk of immediate PPB was increased in patients on continued APAs (6.2% vs 1.4%; p<0.001) but all bleeding episodes were successfully treated during the procedure, and no delayed PPB was observed.…”

Section: Polypectomy On Antithrombotic Therapymentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Vanbiervliet²,

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Metz et al showed a significant association between PPB and aspirin, but the study was conducted on large colonic lesions [20]. According to evidence from a meta-analysis [21], thienopyridines such as clopidogrel increase the risk of delayed PPB (pooled relative risk for PPB of 2.54; 95% CI, 1.68–3.84; p <0.00001). ESGE guidelines recommend interruption of thienopyridines before polypectomy only if the patient had no recent thrombotic event or a coronary drug-eluting stent placed >12 months previously [13].…”

Section: Discussionmentioning

confidence: 99%

Colonic Postpolypectomy Bleeding Is Related to Polyp Size and Heparin Use

et al. 2017

View full text Add to dashboard Cite

Background/AimsWe studied factors influencing colon postpolypectomy bleeding (PPB), with a focus on antithrombotic and anticoagulation therapy.MethodsWe conducted a retrospective case-control study of all patients who underwent polypectomy at our tertiary referral center in Italy between 2007 and 2014. Polyp characteristics (number of polyps removed per patient, size, morphology, location, resection technique, prophylactic hemostasis methods) and patient characteristics (age, sex, comorbidities, medication) were analyzed.ResultsThe case and control groups included 118 and 539 patients, respectively. The two groups differed in the frequency of comorbidities (69% vs. 40%, p=0.001), polyps removed (27% vs. 18%, p=0.02), and use of heparin therapy (23% vs. 1%, p<0.001). A total of 279 polyps in the case group and 966 in the control group were nonpedunculated (69% vs. 81%, p=0.01) and measured ≥10 mm (78% vs. 32%, p=0.001). Multivariate analysis showed that polyps ≥10 mm (odds ratio [OR], 6.1; 95% confidence interval [CI], 2.3–15.5), administration of heparin (OR, 16.5; 95% CI, 6.2–44), comorbidity (OR, 2.3; 95% CI, 1.4–3.9), and presence of ≥2 risk factors (OR, 3.2; 95% CI, 1.7–6.0) were associated with PPB.ConclusionsThe incidence of PPB increases with polyp size ≥10 mm, heparin use, comorbidity, and presence of ≥2 risk factors.

show abstract

Meta‐analysis: colonoscopic post‐polypectomy bleeding in patients on continued clopidogrel therapy

Cited by 59 publications

References 20 publications

Heparin bridge therapy and post-polypectomy bleeding

Heparin bridge therapy and post-polypectomy bleeding

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Colonic Postpolypectomy Bleeding Is Related to Polyp Size and Heparin Use

Contact Info

Product

Resources

About