The effect of discontinuation of aspirin on colonoscopic postpolypectomy bleeding

Abstract

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.

International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy

“…A retrospective study showed that discontinuation of aspirin was an independent protective factor for PPB (hazard ratio [HR], 0.13; 95% CI, 0.03–0.75; p =0.022), especially when the polyp was ≥12 mm. 52 …”

“…the polyp was ≥12 mm. 52 A large retrospective cohort study including consecutive patients undergoing colonoscopic polypectomy reported that thromboembolic events occurred in two out of 487 patients (0.41%) who continued aspirin during the procedures and two out of 568 patients (0.35%) who stopped aspirin before the procedure. 53 Considering the rate of thromboembolic events in aspirin users, aspirin may be discontinued during ultra-highrisk procedures.…”

Dilemma of colonoscopic polypectomy

“…Yao et al investigated the risk factors of PPB and effect of aspirin on PPB. Previous studies usually divided PPB to immediate (intraprocedural bleeding) and delayed (postprocedural bleeding) despite various definitions among studies.…”