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

Abstract

The usage of direct oral anticoagulants (DOACs) to prevent and treat thromboembolic events is gradually increasing. We aimed to evaluate the outcomes of patients taking DOACs after polypectomy. We retrospectively reviewed 131 patients taking DOACs and 270 taking clopidogrel who underwent polypectomy between November 2010 and December 2017. The risk of delayed postpolypectomy bleeding (PPB) was evaluated and compared. A total of 989 polyps were removed (320 polyps in the DOAC and 669 polyps in the clopidogrel group). DOACs and clopidogrel were discontinued for 2.8 ± 1.7 days and 5.8 ± 2.5 days before polypectomy, respectively. DOACs and clopidogrel were restarted on 1.6 ± 2.9 days and 1.7 ± 1.1 days after polypectomy, respectively. According to per polyp analysis, delayed PPB rate was 1.6% in both groups (p = 0.924). Logistic regression analysis was performed after propensity score matching and revealed that DOACs did not increase the delayed PPB risk compared to clopidogrel (OR 0.929, 95% CI 0.436–1.975, p = 0.847). With the majority following the antithrombotic discontinuation guidelines, the incidence of delayed PPB was 3.1% in the patients taking DOACs. The delayed PPB risk was not greater in those taking DOACs than in those taking clopidogrel.

Periprocedural Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant Undergoing a Digestive Endoscopy

“…Figure 1 displays the relationship between the timing of the bleeding event and postendoscopic DOAC resumption, demonstrating a similar bimodal distribution of bleeding events as in patients not taking anticoagulants (28). The incidence of bleeding events, although similar to some reports (29), most of whom addressed postpolypectomy bleeding (30,31), was lower than that reported in most large cohorts of patients on DOAC undergoing a wide range of endoscopic procedures (6.7%–9.9%). This discrepancy may be because of the performance of higher-risk procedures and the use of heparin bridging in the latter (25,26,32,33).…”

Safe, efficient, and effective screening colonoscopy

“…Current research continues to support these guidelines [9,10 ▪ ]. However, recent data reveals a significant rate of postpolypectomy bleeding (PPB) even when these guidelines are followed for both APs and anticoagulants estimated to be between 1–2% so patients should be advised to monitor for bleeding per rectum after careful resumption of these medications [11 ▪ ]. Nonurgent screening colonoscopy should be delayed if possible if the risk of holding any of these agents outweighs the benefit, for example following the new placement of a coronary drug-eluting stent.…”

Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients

“… 37 A retrospective case-matched analysis comparing DOACs to clopidogrel in patients undergoing polypectomy of predominantly <10mm polyps identified no difference in DPPB which occurred in 3% in both groups. 38 Prophylactic clipping was more commonly performed in the DOAC group. 38 Within the DOAC class, apixaban has been associated with a lower risk of post polypectomy bleeding than rivaroxaban, dabigatran and warfarin.…”

“… 38 Prophylactic clipping was more commonly performed in the DOAC group. 38 Within the DOAC class, apixaban has been associated with a lower risk of post polypectomy bleeding than rivaroxaban, dabigatran and warfarin. 39 …”