Heparin bridge therapy and post-polypectomy bleeding

Abstract

AIMTo identify risk factors for post-polypectomy bleeding (PPB), focusing on antithrombotic agents.METHODSThis was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed.RESULTSPPB occurred in 29 (3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210 (26.6%) patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB (P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB (P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant.CONCLUSIONPatients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.

Heparin‐bridging therapy and risk of post‐polypectomy bleeding: Meta‐analysis of data reported by Japanese colonoscopists

“…Eight articles were excluded after the fulllength review (five articles did not report the outcome of interest and three articles did not have participants with heparin-bridging therapy). Therefore, five studies (four retrospective cohort studies and one case-control study) [20][21][22][23][24] consisting of 2601 patients were included in the metaanalysis. File S2 outlines the search methodology and study selection process.…”

“…Therefore, five studies (four retrospective cohort studies and one case-control study) [20][21][22][23][24] consisting of 2601 patients were included in the metaanalysis. After the exclusion of 52 duplicated articles, 1386 articles underwent title and abstract review.…”

Colonic endoscopic mucosal resection in patients taking anticoagulants: Is heparin bridging therapy necessary?

“…In the Japan Gastroenterological Endoscopy Society guidelines, peri‐procedural heparin bridging therapy (HBT) is recommended in patients who have a high risk of thromboembolism after antithrombotic therapy is interrupted, because low‐molecular‐weight heparin is thought to be safe and effective on the treatment of venous thromboembolism . However, recent studies, including a nationwide multicenter survey, have indicated that HBT increases the risk of post‐procedural bleeding . The safety of HBT during endoscopic interventions is thus still unclear.…”

“…6 However, recent studies, including a nationwide multicenter survey, have indicated that HBT increases the risk of post-procedural bleeding. [7][8][9] The safety of HBT during endoscopic interventions is thus still unclear. We aimed to evaluate peri-procedural HBT in patients taking anticoagulants who underwent colonic endoscopic mucosal resection (EMR).…”

Prediction and Prevention of Postpolypectomy Bleeding: Necessity of a Different Approach for Patients Using Antithrombotic Agents

“…These results suggest that the use of heparin as a bridge therapy alone cannot eliminate bleeding associated with polypectomy. A recent similar case-control study also demonstrated that an increased postpolypectomy bleeding incidence was observed regardless of antithrombotic agent discontinuation and use of heparin bridging therapy [11]. Therefore, careful assessment of individual risk before polypectomy is warranted.…”