Patients Prescribed Direct-Acting Oral Anticoagulants Have Low Risk of Postpolypectomy Complications

Abstract

Background & Aims: Use of direct-acting oral anticoagulants (DOACs) is increasing, but little is known about the associated risks in patients undergoing colonoscopy with polypectomy. We aimed to determine the risk of post-polypectomy complications in patients prescribed DOACs. Methods: We performed a retrospective analysis using the Clinformatics Data Mart Database (a de-identified administrative database from a large national insurance provider) to identify adults who underwent colonoscopy with polypectomy or endoscopic mucosal resection (EMR) from January 1, 2011, through December 31, 2015. We collected data from 11,504 patients prescribed antithrombotic agents (1590 DOAC, 3471 warfarin, and 6443 clopidogrel) and 599,983 patients not prescribed antithrombotics of interest (controls). We compared 30-day post-polypectomy complications, including gastrointestinal bleeding (GIB), cerebrovascular accident (CVA), myocardial infarction (MI), and hospital admissions, of patients prescribed DOACs, warfarin, or clopidogrel vs controls. Results: Post-polypectomy complications were uncommon but occurred in a significantly higher proportion of patients receiving any antithrombotic vs controls (P<0.001). The percentage of patients in the DOAC group with GIB was 0.63% (95% CI, 0.3%-1.2%) vs 0.2% (95% CI, 0.2%-0.3%) in controls. The percentage of patients with CVA in the DOAC group was 0.06% (95% CI, 0.01%-0.35%) vs 0.04% (95% CI, 0.04%-0.05%) in controls. After we adjusted for bridge anticoagulation, EMR, Charlson comorbidity index (CCI), and CHADS 2 (congestive heart failure, hypertension, age over 75, diabetes, stroke [double weight]) score, patients prescribed DOACs no longer had a

Is Submucosal Injection Helpful in Cold Snare Polypectomy for Small Colorectal Polyps?

“…25,26 DOACs have been reported to be relatively safe compared to warfarin in terms of postpolypectomy bleeding. 27,28 Conversely, based on our results, a recent study reported that PPB risk was similar between patients taking warfarin and those taking DOACs. 29 Longer duration of anticoagulant use interruption prior to colonoscopy would possibly reduce bleeding risks associated with residual anticoagulant activity; however, this may expose patients to a higher risk of cardiovascular complications.…”

Risk of postpolypectomy bleeding in patients taking direct oral anticoagulants or clopidogrel

“…Therefore, if immediate PPB occurs in patients taking either DOAC or clopidogrel, these patients should be carefully monitored. A previous study suggested that EMR was an independent risk factor of delayed PPB 15 . However, no association of the polypectomy methods with the risk of delayed PPB was observed in our study, which may be due to the relatively small average polyp size in this study.…”

“…The propensity score-matched case–control analysis revealed no difference in the delayed PPB rate per polypectomy site between the two groups (1.6% in both groups). Meanwhile, a recent large retrospective study analyzed the risk of GI bleeding within 30 days after polypectomy in patients taking DOAC, clopidogrel, warfarin, or no antithrombotic agent 15 . It reported a delayed PPB rate in the DOAC group of 0.6%, and the risk of delayed PPB did not increase in the DOAC group in comparison with the control (no antithrombotic agent) group (OR 0.90, 95% CI 0.44–1.85).…”

“…However, there is still a lack of evidence regarding the risk of PPB in those taking DOACs. Interestingly, a recent large-scale retrospective study about postpolypectomy adverse events suggested that not only warfarin but also clopidogrel carried a higher risk of PPB than DOACs 15 . Because clopidogrel has been used for a long time, it is familiar to the clinician and the associated risk of PPB has been well-investigated through previous studies.…”

Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature

“…Similarly, the second mentioned analysis of 11504 comparing patients on antithrombotic therapy (1590 DOACs, 3471 warfarin, and 6443 clopidogrel) and 599983 control undergoing colonoscopy with polypectomy or endoscopic mucosal resection, showed that subjects undergoing DOACs did not have a statistically significant increased risk gastrointestinal bleeding, as well as cerebrovascular accident or myocardial infarction and hospital admissions compared with controls. On the contrary, clopidogrel and warfarin were associated with increased odds of PPB, cerebrovascular accident or myocardial infarction and hospital admissions compared with controls[ 43 ].…”