Heparin‐bridging therapy is associated with a high risk of post‐polypectomy bleeding regardless of polyp size

Ishigami, Hideaki; Arai, Makoto; Matsumura, Tomoaki; Maruoka, Daisuke; Minemura, Shoko; Okimoto, Kenichiro; Kasamatsu, Shingo; Saito, Keiko; Nakagawa, Tomoo; Katsuno, Tatsuro; Yokosuka, Osamu

doi:10.1111/den.12692

Cited by 32 publications

(31 citation statements)

References 28 publications

(74 reference statements)

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“…Among the antithrombotic agents, HB therapy has been reported to be a strong risk factor for PPB [7,15,30,31]. Ishigami et al [31] reported that the OR of PPB in patients treated with HB was 9.8 compared with that of patients without antithrombotic treatment. This result was comparable with our study, in that patients with HB showed a much higher PPB risk than those without antithrombotic agents (OR 33.1 per patient, 17.3 per lesion).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

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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“…Inoue et al[14] demonstrated that the incidence of PPB was significantly higher in a heparin bridge group than in a non-heparin bridge group (20.0% vs 1.4%, respectively). Ishigami et al[22] also demonstrated that heparin-bridging therapy is associated with a high risk of PPB regardless of polyp size.…”

Section: Discussionmentioning

confidence: 99%

Heparin bridge therapy and post-polypectomy bleeding

Kubo

Yamashita

Onodera

et al. 2016

WJG

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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.

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Heparin‐bridging therapy is associated with a high risk of post‐polypectomy bleeding regardless of polyp size

Abstract: Heparin-bridging therapy is associated with a high risk of PPB regardless of polyp size.

Cited by 32 publications

References 28 publications

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

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

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

Heparin bridge therapy and post-polypectomy bleeding

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