Colonoscopic polypectomy in anticoagulated patients

Abstract

Polypectomy can be performed in therapeutically anticoagulated patients with lesions up to 1 cm in size with an acceptable bleeding rate.

Bleeding after percutaneous endoscopic gastrostomy is linked to serotonin reuptake inhibitors, not aspirin or clopidogrel

“…54,55 The data regarding clopidogrel use in higher risk endoscopic procedures is more limited. 56,57 In contrast to aspirin, which irreversibly inhibits platelet cyclooxygenase activity, thus preventing the synthesis of prostaglandins and thromboxane A 2 , 58 clopidogrel blocks platelet aggregation by irreversibly inhibiting the adenosine phosphateinduced activation of the platelet fibrinogen (glycoprotein IIb/IIIa) receptor. 59 Like aspirin, clopidogrel irreversibly inhibits platelet function, and its antiplatelet effects can persist for 7 to 10 days after stopping the drug.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…This was despite routine prophylactic clipping of polypectomies. 6 In a randomised controlled trial (RCT) (159 polyps <1 cm in 70 patients) examining hot versus cold snaring of polyps in anticoagulated patients, the rate of immediate haemorrhage in the hot snare versus the cold snare group was 23.0% vs 5.7%, respectively, and that of delayed haemorrhage requiring intervention 14% vs 0%, respectively. 7 These findings should be considered in the context that polyps have been found at colonoscopy in 22.5-32.1% of patients in large studies 8 9 and up to 42% in a bowel cancer screening programme, 10 many will be greater than 1 cm in size, and the rates of haemorrhage in the latter study above were greater than the 0.07-1.7% overall rates of haemorrhage reported in non-anticoagulated patients.…”

Optimal timing of anticoagulation pre- and post-colonoscopy with polypectomy

“…The risk of clinically significant post-polypectomy bleeding with the use of aspirin has been reported as low as 0.5% and suspending therapy is usually not recommended [4,6,7,[10][11][12].…”