Colonoscopy with polypectomy in anticoagulated patients

Area of Science:

• Gastroenterology
• Cardiology
• Endoscopy

Background:

• Current guidelines recommend discontinuing anticoagulation for colonoscopic polypectomy due to perceived high bleeding risk.
• This recommendation is based on expert opinion, lacking empirical data on bleeding risk in anticoagulated patients.

Purpose of the Study:

• To assess the risk of postpolypectomy bleeding in patients undergoing colonoscopic polypectomy while maintaining anticoagulation.
• To evaluate the safety and efficacy of immediate prophylactic clipping after polypectomy in anticoagulated patients.

Main Methods:

• A retrospective review of 21 patients (41 polypectomies) on long-term warfarin anticoagulation.
• Warfarin was withheld for 36 hours pre-procedure with a liquid diet; average INR was 2.3.
• Polypectomy of small polyps (average 5 mm) followed by immediate prophylactic clip application.

Main Results:

• No postpolypectomy bleeding episodes were observed in any patient.
• The 95% confidence interval for bleeding risk was 0%–8.6% per polypectomy and 0%–15% per patient.

Conclusions:

• Immediate prophylactic clipping after polypectomy in anticoagulated patients appears to carry a very low risk of bleeding for small polyps.
• This approach may offer an alternative to anticoagulation cessation, potentially mitigating thrombosis risks.
• Further multicenter studies are warranted to confirm these findings in larger populations.