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Meta-analysis: colonoscopic post-polypectomy bleeding in patients on continued clopidogrel therapy

S Gandhi1, N Narula, W Mosleh

  • 1Division of Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Alimentary Pharmacology & Therapeutics
|March 28, 2013
PubMed

Insights

Continuing clopidogrel therapy during colonoscopic polypectomy increases the risk of delayed post-polypectomy bleeding. However, interrupting this antiplatelet medication may cause serious ischemic events in high-risk patients.

Area of Science:

  • Gastroenterology
  • Cardiology
  • Clinical Pharmacology

Background:

  • Current guidelines recommend discontinuing clopidogrel 5-10 days before colonoscopic polypectomy.
  • Recent studies suggest similar post-polypectomy bleeding (PPB) rates with continued clopidogrel compared to controls.

Purpose of the Study:

  • To assess the risk of colonoscopic post-polypectomy bleeding (PPB) in patients maintained on clopidogrel therapy.

Main Methods:

  • A meta-analysis of five observational studies involving 574 patients on clopidogrel and 6169 controls.
  • Primary outcome: pooled relative risk (RR) of PPB.
  • Secondary outcomes: comparison of immediate and delayed PPB.

Main Results:

  • Continued clopidogrel therapy was associated with a significantly increased overall risk of PPB (RR = 2.54).
  • Delayed PPB risk was significantly elevated (RR = 4.66), while immediate PPB risk was not significantly different (RR = 1.76).

Conclusions:

  • Continued clopidogrel therapy increases the risk of delayed post-polypectomy bleeding but not immediate bleeding.
  • For high-risk patients, clinicians must weigh the risk of bleeding against potential ischemic events from clopidogrel interruption.
Abstract

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