Post-polypectomy bleeding in hot-snare polypectomy of colonic polyps under continued warfarin or short interruption of direct oral anticoagulants

Shimodate, Yuichi; Ueno, Masashi; Sunami, Tomohiko; Takayama, Hiromitsu; Takezawa, Rio; Doi, Akira; Nishimura, Naoyuki; Mouri, Hirokazu; Matsueda, Kazuhiro; Yamamoto, Hiroshi; Mizuno, Motowo

doi:10.1007/s00384-019-03373-4

Cited by 2 publications

(5 citation statements)

References 15 publications

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“…Detailed information about the excluded studies is presented in the supporting information. Eventually, 30 articles were included 24–53 …”

Section: Resultsmentioning

confidence: 99%

“…Only two studies mentioned the usage of epinephrine as injection solution 50,53 . As for the types of DOACs, 14 (46.67%) studies included dabigatran, rivaroxaban, apixaban, and edoxaban 24–28,32–38,41,43 . And five studies reported that the duration of withdrawal of antithrombotic agents was determined according to the guidelines published by the JGES 24,25,28,31,44 .…”

Section: Resultsmentioning

confidence: 99%

“…And five studies reported that the duration of withdrawal of antithrombotic agents was determined according to the guidelines published by the JGES 24,25,28,31,44 . For DOACs, HB was applied in 17 studies 24,25,27,29,31–34,36,37,39,42,45,46,48,50,52 . Six studies just discontinued DOACs before the endoscopic procedures without the usage of HB 26,28,35,40,41,49 .…”

Section: Resultsmentioning

confidence: 99%

“…Six studies just discontinued DOACs before the endoscopic procedures without the usage of HB 26,28,35,40,41,49 . For warfarin, 22 studies mentioned HB before the procedures 24,25,27,29,31–37,39–42,45,46,48–50,52,53 . One study focused on the cold polypectomy‐continued DOACs and warfarin during procedures 30 .…”

Section: Resultsmentioning

confidence: 99%

“…No study selected the community population as the control group. Fourteen studies did not report the non‐response rate 25,28–30,34,38,39,41,42,44,49–52 . The detailed information about each item of NOS is provided in the supporting information.…”

Section: Resultsmentioning

confidence: 99%

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Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Zhu

Tao

et al. 2021

J of Gastro and Hepatol

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Background and Aim Oral anticoagulants are risk factors for post‐endoscopic resection bleeding. We aimed to conduct a systematic review and meta‐analysis for the risks of post‐procedural bleeding (PPB) for direct oral anticoagulants (DOACs) and warfarin following endoscopic resection. Methods Two independent reviewers searched PubMed, Web of Science, Embase, and Cochrane Library. The Newcastle–Ottawa Scale score was used to assess the quality of the studies, the pooled odds ratio (OR) to present PPB results, and the funnel plots to assess publication bias. The Higgins I2 statistic was employed to determine the variation across studies due to heterogeneity. Results We reviewed 30 articles. PPB occurred in 586 patients on DOACs and 1782 on warfarin. The patients on DOACs had a significantly lower overall risk of PPB compared with those on warfarin (OR, 0.867, 95% confidence interval, 0.771–0.975; P = 0.017, I2 = 1.6%). Cumulative meta‐analysis showed that the PPB rate of DOACs has the trend to be lower than that of warfarin with publication year and sample size. For the subgroup of endoscopic submucosal dissection, the PPB of DOACs was significantly lower than that of warfarin (OR, 0.786; 95% confidence interval, 0.633–0.976; P = 0.029, I2 = 0%). No significant difference was observed between DOACs and warfarin for anticoagulant strategies, endoscopic procedures, and lesion location. Conclusions Compared with warfarin, DOACs have the possibility to significantly decrease the risk of PPB following endoscopic resection, especially for endoscopic submucosal dissection.

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“…Detailed information about the excluded studies is presented in the supporting information. Eventually, 30 articles were included 24–53 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Zhu

Tao

et al. 2021

J of Gastro and Hepatol

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Risk of delayed bleeding after hot snare polypectomy and endoscopic mucosal resection in the colorectum with continuation of anticoagulants

Kobayashi¹,

Takeuchi²,

Hojo³

et al. 2021

J Gastrointest Oncol

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Background: Current guidelines recommend the temporary discontinuation of anticoagulants before colonoscopic polypectomy, but the effect of this practice on reducing the risk of delayed bleeding after hot snare polypectomy (HSP) and endoscopic mucosal resection (EMR) remains unclear. Our aim was to assess the impact of anticoagulants on the risk of colorectal delayed bleeding after HSP and EMR, and evaluate the necessity of drug withdrawal. Methods: We reviewed the clinical data of patients with colorectal polyps using antithrombotic drugs who underwent HSP and/or EMR between January 2016 and September 2020 at Nagaoka Red Cross Hospital. After excluding antiplatelet users, patients were classified into those who continued anticoagulants [continuation group: 50 patients (93 lesions)] and those who discontinued anticoagulants [discontinuation group: 87 patients (190 lesions)].Results: Delayed bleeding occurred in 12 lesions, and there was no significant difference in the incidence rates between the continuation and the discontinuation groups (3.2% vs. 4.7%; P=0.756). Logistic regression analysis showed that continued use of anticoagulants was not a significant risk factor for delayed bleeding compared to anticoagulant discontinuation (odds ratio, 0.670; 95% CI, 0.177-2.537; P=0.556). There was no significant difference in the incidence rate and risk of delayed bleeding, regardless of the length of the anticoagulant withdrawal period.Conclusions: Continued use of anticoagulants, compared to their discontinuation, did not increase the risk of colorectal delayed bleeding after HSP and EMR. Our results suggest that current guideline recommendations for anticoagulant withdrawal before colonoscopic polypectomy may be reconsidered.

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Post-polypectomy bleeding in hot-snare polypectomy of colonic polyps under continued warfarin or short interruption of direct oral anticoagulants

Cited by 2 publications

References 15 publications

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Bleeding after endoscopic resection between direct oral anticoagulants or warfarin: Systematic review and meta‐analysis

Risk of delayed bleeding after hot snare polypectomy and endoscopic mucosal resection in the colorectum with continuation of anticoagulants

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