Effect of nabumetone and aspirin on colonic mucosal bleeding time

Abstract

Although evidence that aspirin and NSAIDs increase the risk of signi®cant bleeding after colonic polypectomy is lacking, aspirin prolongs colonic mucosal bleeding and NSAID use predisposes to minor bleeding after upper or lower endoscopy and biopsy or polypectomy. 1±3 The rate of major bleeding in the latter study was too low to assess an NSAID effect.Concerns about bleeding after polypectomy in aspirin or NSAID users have prompted three strategies. First, dermal bleeding times are used to screen patients before signi®cant polypectomy. However, bleeding times in the colonic mucosa (`endoscopic bleeding time') may not correlate with skin bleeding times in NSAID users. 2 Second, endoscopy is performed during NSAID use and patients with lesions are asked to cease NSAIDs before a second endoscopy for biopsy or polypectomy. In a population at high risk for lesions, this may be uncomfortable, expensive, and complication-prone. Third, all patients are asked to stop aspirin and NSAIDs 1±2 weeks in advance, engendering considerable discom®ture in patients who require NSAIDs for analgesia. NSAIDs with little effect on platelet function in vivo provide a potentially attractive alternative as a bridge to and through endoscopy. Such NSAIDs would include nabumetone, which has insuf®cient effect on thromboxane synthesis in vivo (COX-1 mediated) to substantially affect platelet aggregation, and selective COX-2 inhibitors, which do not affect COX-1 at therapeutic SUMMARY Background: The management of patients taking aspirin or non-steroidal anti-in¯ammatory drugs (NSAIDs) who require colonoscopy remains controversial because of concerns over bleeding after biopsy or polypectomy. Aim: To determine whether patients using the NSAID nabumetone, a non-acidic prodrug with mixed activity against cyclooxygenase-1 (COX-1) and COX-2, exhibited prolonged mucosal bleeding times and how this might compare with mucosal bleeding times in patients using aspirin. Methods: We assessed triplicate mucosal bleeding times in patients undergoing screening¯exible sigmoidoscopy. We compared 90 patients who had taken no aspirin or NSAIDs within the previous 2 weeks, to 60 patients

Risk Factors for Immediate Postpolypectomy Bleeding of the Colon: A Multicenter Study

“…Several studies have suggested that patient-related factors (e.g., prior aspirin or anticoagulant use) (8)(9)(10), polyp-related characteristics, and procedure-related factors such as the type of electrosurgical current or submucosal injection solution (11) may confer a high risk for PPB (12)(13)(14)(15)(16)(17). Although it has been suggested that patient-related, polyp-related, and procedure-related factors are strongly associated with PPB, few studies have evaluated the potential risk factors for immediate PPB (IPPB) in patients with colorectal polyp, and compared the identified risk factors of patients with and without IPPB, or examined potential risk factors by multivariate analysis.…”

Polipektomi sonrası kanamada endoskopik bant ligasyonunun kullanımı

“…Antiplatelet agents (including aspirin, non-steroidal anti-inflammatory drugs [NSAIDs], ticlopidine, clopidogrel, and glycoprotein IIb/IIIa receptor antagonists) and anticoagulants may increase the risk of postpolypectomy bleeding (10)(11)(12). Our patient had a history of warfarin use, and her international normalized ratio (INR) level was very high.…”

Guidelines for the management of antiplatelet and anticoagulant therapy in patients undergoing endoscopic procedures. Recommendations of the Working Group of the Polish Society of Gastroenterology and the Polish Consultant in Gastroenterology

“…W badaniach oceniających ryzyko krwawienia podczas endoskopii z biopsją u pacjentów przyjmujących leki przeciwpłytkowe (kwas acetylosalicylowy i/lub klopidogrel) wykazano brak wydłużenia czasu krwawienia błony śluzowej żołądka oraz wydłużenie czasu krwawienia błony śluzowej jelita grubego, ale bez istotnych następstw klinicznych [8][9][10][11][12].…”