Colonoscopy with Polypectomy in Patients Taking Clopidogrel

Friedland, Shai; Leung, Cynthia W.; Sedehi, Daniel; Soetikno, Roy

doi:10.1016/j.gie.2008.03.831

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…However, the PPB risk was not different between groups that did not discontinue aspirin if polyp size <1.2 cm (Figure ). This result was similar to ESGE guideline and Friedland's study …”

Section: Discussionsupporting

confidence: 92%

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The effect of discontinuation of aspirin on colonoscopic postpolypectomy bleeding

Yao

Chiu

et al. 2019

Adv in Digestive Medicine

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Bleeding is one of the most common complications after colonoscopic polypectomy. Several factors associated with postpolypectomy bleeding (PPB) have been discussed, but whether aspirin increases the risk remains controversial, and the effect of the discontinuation of aspirin on PPB is still unclear. We aim to identify the risk factors of PPB and to assess the effect of aspirin on PPB. Patients undergoing colonoscopic polypectomy between November 2013 and September 2014 were recruited to the retrospective study. Patients' demographics, clinical parameters, polyp characteristics, using of antithrombotics, and the prevalence of PPB were reviewed from electronic medical records. Multiple regression analysis was performed to identify independent risk factors associated with PPB. A total of 497 patients with 827 polyps removed were recruited to this study. The bleeding rate was significantly higher in patients on aspirin therapy (17.3% vs 6.3%, P = .005). In multiple logistic regression analysis, aspirin users (hazard ratio [HR]: 3.67, 95% confidence interval [CI]: 1.51‐8.89, P = .007) and bigger polyp removal (cut level 11.5 mm, HR: 1.14, 95% CI: 1.06‐1.23, P = .001) were the significant factors. In aspirin users, discontinuation of aspirin for 7 days before polypectomy was the independent protective factor of bleeding (HR: 0.13, 95% CI: 0.03‐0.75, P = .022), especially when the polyp was ≧12 mm. Our study found that use of aspirin and bigger polyp size are associated with colonoscopic postpolyectomy bleeding. Discontinuation of aspirin before polypectomy could decrease the bleeding while the polyp size was greater than 12 mm.

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“…However, the PPB risk was not different between groups that did not discontinue aspirin if polyp size <1.2 cm (Figure ). This result was similar to ESGE guideline and Friedland's study …”

Section: Discussionsupporting

confidence: 92%

“…This result was similar to ESGE guideline and Friedland's study. 29,30 There are a few limitations of this study. First, this was a single-center retrospective study, and therefore, selection bias was possible.…”

Section: Discussionmentioning

confidence: 95%

The effect of discontinuation of aspirin on colonoscopic postpolypectomy bleeding

Yao

Chiu

et al. 2019

Adv in Digestive Medicine

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“…Despite these differences, all studies found that the risk of significant PPB was not increased by aspirin use. The influence of clopidogrel intake on PPB has been analyzed in two retrospective studies including 202 patients taking clopidogrel (associated with aspirin/NSAID use in 27 %) undergoing 500 polypectomies (polyp size ≤ 10 mm in 93 % of cases) [41,42]. In 6 % of patients, the polypectomy was associated with immediate bleeding which was successfully treated by endoclip placement.…”

Section: Resection Of Colonic Polypsmentioning

confidence: 99%

Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2011

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“…” One of the fundamental difficulties with deciding how to manage clopidogrel in patients undergoing colonoscopy is that the risk of post-polypectomy bleeding in this setting is not known [6-8]. Our anecdotal experience has suggested that the bleeding risk is not exceptionally high when small polyps are resected, and based on this we have been routinely performing polypectomy of lesions up to 1 cm in size without interruption of clopidogrel [9]. …”

Section: Introductionmentioning

confidence: 99%

Colonoscopy with Polypectomy in Patients Taking Clopidogrel

2009

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Background and AimsTo investigate the bleeding risk of colonoscopy with polypectomy in patients taking clopidogrel.MethodsRetrospective review of patients undergoing colonoscopy with polypectomy without interruption of clopidogrel. Patients with lesions larger than 1cm were generally rescheduled for polypectomy off clopidogrel. Most of the polyps were removed using cold snare technique. Endoscopic clips were routinely applied prophylactically.ResultsA total of 125 polypectomies were performed in 60 patients. The average polyp size was 5.4 ± 2.1 mm. One patient (1.7%, CI 0.3-8.9%) developed post-polypectomy bleeding that resolved without treatment. Three patients (5%, CI 1.7-14%) had immediate bleeding during the procedure and all resolved with prompt clip application.ConclusionsPolypectomy of lesions up to 1cm in size can be performed without interruption of clopidogrel.

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Colonoscopy with Polypectomy in Patients Taking Clopidogrel

Cited by 6 publications

References 16 publications

The effect of discontinuation of aspirin on colonoscopic postpolypectomy bleeding

The effect of discontinuation of aspirin on colonoscopic postpolypectomy bleeding

Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Colonoscopy with Polypectomy in Patients Taking Clopidogrel

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