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Colonoscopic polypectomy in anticoagulated patients
Shai Friedland1, Daniel Sedehi, Roy Soetikno
1Division of Gastroenterology, VA Palo Alto and Stanford University, 3801 Miranda Avenue, Palo Alto, CA 94304, USA. shai_friedland@yahoo.com
World Journal of Gastroenterology
|April 29, 2009
Summary
Polypectomy in anticoagulated patients is safe for polyps up to 1 cm. This study found a low bleeding rate, suggesting continued anticoagulation is feasible for select patients.
Area of Science:
- Gastroenterology
- Endoscopy
- Cardiology
Background:
- Anticoagulation therapy is crucial for preventing thromboembolic events but poses a bleeding risk during endoscopic procedures.
- Interruption of anticoagulation increases stroke risk, necessitating careful management during polypectomy.
Purpose of the Study:
- To evaluate the safety and efficacy of performing colorectal polypectomy in patients maintained on therapeutic anticoagulation.
- To determine the post-polypectomy bleeding rate in anticoagulated patients.
Main Methods:
- Retrospective chart review of 225 polypectomies in 123 anticoagulated patients.
- Standardized protocol included a 36-hour warfarin cessation for bowel prep; lesions >1 cm were typically rescheduled.
- Prophylactic endoscopic clip application was routinely used.
Main Results:
- A low rate of major post-polypectomy bleeding (0.8%) requiring transfusion was observed.
- An additional 1.6% experienced self-limited hematochezia without requiring medical attention.
- The average polyp size was 5.1 mm.
Conclusions:
- Colorectal polypectomy can be safely performed in therapeutically anticoagulated patients for lesions up to 1 cm.
- The observed bleeding rates are acceptable, supporting the continuation of anticoagulation in carefully selected cases.
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