Risk of Gastrointestinal Endoscopic Procedure-Related Bleeding in Patients With or Without Continued Antithrombotic Therapy

Yabe, Kiyoaki; Horiuchi, Akira; Kudo, Toshifumi; Horiuchi, Ichitaro; Ichise, Yasuyuki; Kajiyama, Masashi; Tanaka, Naoki

doi:10.1007/s10620-020-06393-1

Cited by 11 publications

(15 citation statements)

References 16 publications

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“…Our previous study including the resection of pedunculated colorectal polyps showed that delayed bleeding requiring hemostasis occurred significantly less commonly after cold snare than hot snare polypectomy, despite continuation of anticoagulants (0% vs.14%, P=0.027), and that injured submucosal arteries were seen less frequently following cold snare polypectomy (22% vs. 39%, P=0.023) (11). The present data on the rate of delayed bleeding (0%) after a dedicated cold snare polypectomy was in good agreement with our previous findings (6,12).…”

Section: Resultssupporting

confidence: 91%

Pedunculated colorectal polyps with heads ≤ 1 cm in diameter can be resected using cold snare polypectomy

Kudo

Horiuchi

et al. 2021

AGEB

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Background and study aims : Cold snare polypectomy (CSP) is not recommended for the resection of pedunculated colorectal polyp. The aim of this study was to examine the adequacy of CSP compared to hot snare polypectomy (HSP) for the complete resection of pedunculated polyps with heads ≤ 1 cm in diameter. Patients and methods : This was a retrospective study of a cohort of consecutive outpatients who had resection of pedunculated polyps with heads 6-10 mm in diameter using either dedicated CSP or HSP from 2014 through 2019. The primary outcome measure was occurrence of delayed bleeding. Secondary outcome measures included total procedure time, en bloc resection rate, immediate bleeding, and number of clips used. Results : 415 patients with 444 eligible polyps were enrolled; the CSP group (363 patients; 386 polyps) and HSP group (52 patients; 58 polyps). Patient characteristics, polyp characteristics and en bloc resection rate were similar between groups. The mean total procedure time and mean number (range) of hemostatic clips/patient used were significantly lower with CSP than with HSP (18± 8 min vs. 25± 9 min, P<0.001; 1.1 ± 0.6 (1-3) vs.3.1 ± 1.6 (1-5), respectively, P<0.001). Delayed bleeding occurred significantly less frequently in the CSP, 0% (0/363 vs.3.8% (2/52) in the HSP group (P<0.001), although immediate bleeding was significantly higher in CSP than HSP (84% (325/386) vs. 12% (7/58), P<0.001). Conclusion : Pedunculated colorectal polyps with heads ≤ 1 cm can be removed using CSP, which has several advantages over HSP.

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Section: Resultssupporting

confidence: 91%

Pedunculated colorectal polyps with heads ≤ 1 cm in diameter can be resected using cold snare polypectomy

Kudo

Horiuchi

et al. 2021

AGEB

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“…Eight prospective studies (including five randomized controlled trials) and nine retrospective studies were analyzed. Most studies were conducted in East Asia, 3 , 7 , 11 – 17 , 19 , 20 , 23 – 25 and the remaining studies were conducted in Italy, 10 the United States, 22 and Australia/New Zealand. 18 …”

Section: Resultsmentioning

confidence: 99%

Safety of cold snare polypectomy with periprocedural antithrombotic agents for colorectal polyps: a systematic review and meta-analysis

Wang

Lin

Lee

et al. 2022

Therap Adv Gastroenterol

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Background: We aimed to study the safety of cold snare polypectomy (CSP) for colorectal polyps in patients administered periprocedural antithrombotic agents. Methods: We searched the PubMed, Embase, and Cochrane Library databases through June 2021. The primary outcomes were the rates of delayed and immediate bleeding (requiring endoscopic hemostasis). Secondary outcomes included thromboembolic events. Meta-analysis using odds ratios (ORs) and corresponding 95% confidence intervals (CIs) was performed to compare the outcomes. Results: Seventeen studies, including five randomized trials, were included. Over 96% of polyps were ⩽1 cm. The pooled rates of delayed and immediate bleeding for patients receiving CSP and periprocedural antithrombotic agents were 1.6% and 10.5%, respectively. Both the delayed (OR = 4.02, 95% CI = 1.98–8.17) and immediate bleeding (OR = 5.85, 95% CI = 3.84–8.89) rates were significantly higher in patients using periprocedural antithrombotic agents than in non-users. Although both antiplatelet agents and anticoagulants increased the risk of delayed bleeding, the risks associated with the use of direct oral anticoagulants (DOACs; 2.5%) or multiple agents (3.9%) were particularly high. Compared to their counterparts, diminutive polyps and uncomplicated lesions not requiring hemoclipping were associated with lower risks of delayed bleeding (pooled estimates of 0.4% and 0.18%, respectively). Thromboembolic risk was similar among patients using and not using periprocedural antithrombotic agents. Conclusions: CSP with periprocedural antiplatelet agents and warfarin may be feasible, especially for diminutive polyps. However, drug discontinuation should be considered with the use of DOACs or multiple agents which entail higher bleeding risk even with hemoclipping.

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“…10 The subgroup of patients aged 65 years has been correlated with an increased risk of bleeding (.05% vs .17%, P < .001). 9 Although intraprocedural bleeding has been observed in up to 2% to 6% of patients undergoing EGD while on continued antithrombotic therapy, 11,12 this outcome is generally believed to be of limited clinical significance given that it does not usually alter a patient's clinical trajectory. 11 Importantly, the available body of evidence suggests no significant differences in clinically relevant delayed bleeding between patients undergoing diagnostic EGD who do or do not take antithrombotic agents.…”

Section: Bleedingmentioning

confidence: 99%

“…9 Although intraprocedural bleeding has been observed in up to 2% to 6% of patients undergoing EGD while on continued antithrombotic therapy, 11,12 this outcome is generally believed to be of limited clinical significance given that it does not usually alter a patient's clinical trajectory. 11 Importantly, the available body of evidence suggests no significant differences in clinically relevant delayed bleeding between patients undergoing diagnostic EGD who do or do not take antithrombotic agents. [11][12][13][14][15] Also of note, in patients taking antithrombotic agents at baseline, available evidence suggests no differences in clinically significant bleeding outcomes when EGD (with or without biopsy sampling) is performed after appropriate periprocedural cessation of these agents 16 versus when they are continued leading up to and after the procedure.…”

Section: Bleedingmentioning

confidence: 99%

“…11 Importantly, the available body of evidence suggests no significant differences in clinically relevant delayed bleeding between patients undergoing diagnostic EGD who do or do not take antithrombotic agents. [11][12][13][14][15] Also of note, in patients taking antithrombotic agents at baseline, available evidence suggests no differences in clinically significant bleeding outcomes when EGD (with or without biopsy sampling) is performed after appropriate periprocedural cessation of these agents 16 versus when they are continued leading up to and after the procedure. 11,17,18 Based on these and other data, the ASGE guideline on management of antithrombotic agents concludes that there is a low overall risk of bleeding during diagnostic EGD with or without biopsy sampling in patients on all antithrombotic medication.…”

Section: Bleedingmentioning

confidence: 99%

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Adverse events associated with EGD and EGD-related techniques

Coelho–Prabhu

Forbes

Thosani

et al. 2022

Gastrointestinal Endoscopy

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Risk of Gastrointestinal Endoscopic Procedure-Related Bleeding in Patients With or Without Continued Antithrombotic Therapy

Cited by 11 publications

References 16 publications

Pedunculated colorectal polyps with heads ≤ 1 cm in diameter can be resected using cold snare polypectomy

Pedunculated colorectal polyps with heads ≤ 1 cm in diameter can be resected using cold snare polypectomy

Safety of cold snare polypectomy with periprocedural antithrombotic agents for colorectal polyps: a systematic review and meta-analysis

Adverse events associated with EGD and EGD-related techniques

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