Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy

Horiuchi, Akira; Nakayama, Yoshiko; Kajiyama, Masashi; Tanaka, Naoki; Sakai, Kenji; Graham, David Y.

doi:10.1016/j.gie.2013.08.040

Cited by 269 publications

(317 citation statements)

References 25 publications

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“…In regard to lesion factors other than antithrombotic use, our study showed that lesion size ≥10 mm, pedunculated polyp, lesion in the rectum, and resection method with electrocautery were independent PPB risk factors, consistent with previous reports [7,25,27,29,[35][36][37]. On the other hand, malignant histology of carcinoma was not a risk factor for PPB in our study, which was contrary to the report by Dobrowolski et al [25].…”

Section: Discussionsupporting

confidence: 72%

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: Discussionsupporting

confidence: 72%

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

et al. 2018

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“…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. 9 11-14 Routine discontinuation of warfarin therapy may therefore be considered necessary in most colonoscopy services.…”

Section: Warfarinmentioning

confidence: 76%

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

Vanbiervliet²,

et al. 2017

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“…Horiuchi et al [14] reported that delayed bleeding requiring hemostasis occurs significantly less commonly after CSP than after HP despite continuation of warfarin. In our study, there was no case of bleeding with continuation of warfarin or heparin bridging therapy, and CP might therefore be a safe procedure for patients taking anticoagulant drugs.…”

Section: Discussionmentioning

confidence: 99%

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

et al. 2018

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Background: The cold polypectomy (CP) technique has been increasingly used in recent years. However, there have been few studies about post-polypectomy bleeding (PPB) in patients who underwent CP and who were on antithrombotic drugs. The objective of this study was to determine the safety of CP in patients on antithrombotic medication. Methods: The subjects were patients who underwent CP in our hospital between April 2014 and March 2016. PPB rates were examined in relation to the use of antithrombotic medication. Results: CP was performed to remove 2,466 polyps in 1,003 patients. There were 549 polyps (22.3%) in186 patients in the antithrombotic group and 1,917 polyps (77.7%) in 817 patients in the non-antithrombotic group. PPB occurred in 0.55% (3/549) of patients in the antithrombotic group and in 0.10% (2/1,917) of patients in the non-antithrombotic group, showing no significant difference (p = 0.07). Patients in the antithrombotic group in whom PPB occurred included 1 aspirin user with 1 polyp and 1 aspirin plus clopidogrel user with 2 polyps. No PPB occurred in patients on other antithrombotic agents or receiving heparin bridging. There was no significant difference between PPB rates in patients with small polyps (6–9 mm) in the antithrombotic and non-antithrombotic groups, but there was a significant difference between PPB rates in the 2 groups for patients with diminutive group (1–5 mm). Conclusion: CP is a safe procedure even in patients on antithrombotic medication.

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Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy

Cited by 269 publications

References 25 publications

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

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

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

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

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