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The role of aspirin in post-polypectomy bleeding--a retrospective survey
Antony Pan1, Martin Schlup, Ralf Lubcke
1Gastroenterology Unit, Southern District Health Board, Dunedin, New Zealand.
Insights
Patients taking aspirin have a significantly higher risk of lower gastrointestinal bleeding after colonoscopic polypectomy. Caution is advised when performing polypectomy on patients using aspirin.
Area of Science:
- Gastroenterology
- Endoscopy
- Clinical Research
Background:
- Post-polypectomy bleeding is a common complication of colonoscopy, occurring in up to 6.1% of patients.
- Potential risk factors for bleeding remain controversial.
- The study specifically investigated the role of aspirin in post-polypectomy bleeding.
Purpose of the Study:
- To determine the rate of post-polypectomy bleeding.
- To analyze the role of potential risk factors, particularly aspirin use.
Main Methods:
- Retrospective cohort study conducted at Dunedin Hospital, New Zealand.
- Involved analysis of patients who underwent colonoscopic polypectomy between January 2007 and June 2009.
- Excluded patients who had immediate surgery or presented with pre-colonoscopy bleeding symptoms.
Main Results:
- 11 out of 493 patients (2.2%) experienced post-polypectomy bleeding within 30 days.
- Aspirin use was significantly associated with an increased prevalence of bleeding (OR=6.72).
- Non-steroidal anti-inflammatory drug (NSAID) use did not show a significant association with bleeding risk (OR=2.82).
Conclusions:
- Aspirin significantly increases the risk of lower gastrointestinal bleeding after colonoscopic polypectomy.
- Healthcare providers should exercise caution when performing polypectomy on patients taking aspirin.
- Further research may be warranted to explore management strategies for this patient group.
Background:
Bleeding following colonoscopic polypectomy is a common complication and has been reported to occur in up to 6.1% of patients. Several risk factors have been discussed but their overall contribution to post-polypectomy bleeding remains controversial. The aim of the study was to determine the rate of post polypectomy bleeding and to analyse the role of potential risk factors especially the role of aspirin.
Methods:
We conducted a retrospective cohort study of all patients who underwent polypectomy at Dunedin Hospital, New Zealand between January 2007 and June 2009.
Results:
During the study period, 514 patients underwent colonoscopy with polypectomy and a total of 1502 polyps were removed. From further analysis we excluded 21 patients; 15 patients had surgery immediately after colonoscopy for the diagnosis of colorectal carcinoma and 6 patients presented with symptoms of an acute lower gastrointestinal bleed prior to colonoscopy. Of the remaining 493 patients, 11 patients (2.2%) presented with post-polypectomy bleeding within 30 days of the investigation of which 8 were on aspirin. In total 145 patients were taking aspirin prior to colonoscopy and 348 patients were not taking aspirin. The use of aspirin was associated with an increased prevalence of post-polypectomy bleeding (OR=6.72, 95% C.I. 1.76 to 25.7). Interestingly, the use of non-steroidal anti-inflammatory drugs (NSAIDs) was not associated with risk of bleeding after polypectomy (OR=2.82, 95% C.I, 0.34 to 23.3).
Conclusion:
Our study confirmed a significantly increased risk of lower gastrointestinal bleeding following polypectomy in patients taking aspirin. We would recommend approaching the patient on aspirin coming forward for a colonoscopy with potential polypectomy with caution.
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