Clinical features of post‐polypectomy bleeding associated with heparin bridge therapy

Inoue, Takuya; Nishida, Tsutomu; Maekawa, Akira; Tsujii, Yoshiki; Akasaka, Tomofumi; Kato, Motohiko; Hayashi, Yoshito; Yamamoto, Shunsuke; Kondo, Jumpei; Yamada, Takuya; Shinzaki, Shinichiro; Iijima, Hideki; Tsujii, Masahiko; Takehara, Tetsuo

doi:10.1111/den.12123

Cited by 54 publications

(64 citation statements)

References 19 publications

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“…It is known that heparin bridging therapy significantly increases the risk of post-procedural bleeding [10-13]. Horiuchi et al [14] reported that delayed bleeding requiring hemostasis occurs significantly less commonly after CSP than after HP despite continuation of warfarin.…”

Section: Discussionmentioning

confidence: 99%

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

et al. 2018

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Background: The cold polypectomy (CP) technique has been increasingly used in recent years. However, there have been few studies about post-polypectomy bleeding (PPB) in patients who underwent CP and who were on antithrombotic drugs. The objective of this study was to determine the safety of CP in patients on antithrombotic medication. Methods: The subjects were patients who underwent CP in our hospital between April 2014 and March 2016. PPB rates were examined in relation to the use of antithrombotic medication. Results: CP was performed to remove 2,466 polyps in 1,003 patients. There were 549 polyps (22.3%) in186 patients in the antithrombotic group and 1,917 polyps (77.7%) in 817 patients in the non-antithrombotic group. PPB occurred in 0.55% (3/549) of patients in the antithrombotic group and in 0.10% (2/1,917) of patients in the non-antithrombotic group, showing no significant difference (p = 0.07). Patients in the antithrombotic group in whom PPB occurred included 1 aspirin user with 1 polyp and 1 aspirin plus clopidogrel user with 2 polyps. No PPB occurred in patients on other antithrombotic agents or receiving heparin bridging. There was no significant difference between PPB rates in patients with small polyps (6–9 mm) in the antithrombotic and non-antithrombotic groups, but there was a significant difference between PPB rates in the 2 groups for patients with diminutive group (1–5 mm). Conclusion: CP is a safe procedure even in patients on antithrombotic medication.

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Section: Discussionmentioning

confidence: 99%

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

et al. 2018

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“…Based on this guideline, HBT is considered a treatment option for patients who are undergoing colorectal EMR or ESD in the presence of antithrombotic therapy. However, recent retrospective studies addressing the safety and efficacy of HBT in colorectal EMR and EP revealed that HBT increases rather than decreases the risk of POB [22][23][24] . Consistent with the studies cited above, the rate of POB following colorectal ESD tended to be higher in our HBT group than in our no-HBT group, although the difference was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, anticoagulants or antiplatelet agents must be discontinued in patients bearing a low risk of thromboembolism following withdrawal or replaced by heparin bridge therapy (HBT) in patients at high risk of thromboembolism following withdrawal before endoscopic procedures with a high risk of bleeding, such as EMR and ESD [21] . Recent retrospective studies addressing the safety and efficacy of HBT in colorectal EMR and EP revealed that HBT increases rather than decreases the risk of POB [22][23][24] . It should be noted, however, that clinical studies addressing the safety and efficacy of HBT in colorectal ESD are not available.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

Okamoto¹,

Watanabe²,

Komeda³

et al. 2017

Oncology

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antithrombotic therapy and rectal tumor location were strongly associated with POB following colorectal ESD. The incidence of POB was higher in patients on heparin bridge therapy (HBT) for the replacement of antithrombotic therapy than in patients with no HBT. Four of 7 patients (57.1%) on antithrombotic therapy experienced POB from the rectal lesions. Conclusion: Antithrombotic therapy and rectal lesions result in a higher POB incidence after colorectal ESD.

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“…However, the polypectomy procedure carries some risks of complications; one of the most significant complications is post-polypectomy bleeding (PPB), which has an inci-dence rate of 0.3-6.1% [4][5][6]. According to previous reports, antithrombotic agents are one risk factor for PPB [7]. Currently, the number of patients treated with antithrombotics is increasing due to the aging of the population [8].…”

Section: Introductionmentioning

confidence: 99%

Risk Analysis of Colorectal Post-Polypectomy Bleeding Due to Antithrombotic Agent

et al. 2018

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Background/Aims: Post-polypectomy bleeding (PPB) is a major complication of colorectal polypectomy, and antithrombotics is one of the major risk factors of PPB. The purpose of this study was to investigate PPB risks with regard to the combinations of antithrombotic agents used. Methods: We retrospectively reviewed cases involving colonoscopic polyp resection between September 2002 and December 2014. The risk of PPB was assessed according to patient and lesion factors, including antithrombotic use. Antithrombotics were discontinued before polypectomy. Results: A total of 6,382 colonoscopies with 12,876 polypectomies were analyzed. PPB occurred in 55 patients (0.9%) and 63 lesions (0.5%). Among patients treated with antithrombotics, heparin bridging (HB) therapy was an independent risk factor of PPB (per patient, 20%, OR 33.1, p < 0.001; per lesion, 9.1%, OR 17.3, p < 0.001) compared to those without antithrombotics (per patient 0.7%; per lesion 0.4%). Among patients without HB, the combination of anticoagulant + antiplatelet agents was significantly associated with PPB (per patient, 5%, OR 7.73, p = 0.007; per lesion, 2.4%, OR 6.31, p = 0.003). Conclusion: HB therapy is a major risk factor for PPB. Among patients without HB, anticoagulant + antiplatelet therapy was a significant risk factor for PPB.

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Clinical features of post‐polypectomy bleeding associated with heparin bridge therapy

Abstract: PPB associated with HB is characterized by high incidence, late onset and recurrent bleeding, resulting in long hospitalization.

Cited by 54 publications

References 19 publications

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

Risk Analysis of Colorectal Post-Polypectomy Bleeding Due to Antithrombotic Agent

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