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The risk of post-polypectomy bleeding among patients receiving antithrombotic agents: A prospective observational
Hilmi Bozkurt1, Özlem Zeliha Sert2, Tolga Ölmez3
1MD, MSc. General Surgeon, Gastrointestinal Surgeon and Molecular Oncology Doctoral Student, University of Health Sciences, Haseki Research and Education Hospital, Istanbul, Turkey.
Insights
Colonoscopic polypectomy can be safely performed without stopping antithrombotic therapy, according to this study. Continuing these medications did not increase bleeding risk in patients undergoing the procedure.
Area of Science:
- Gastroenterology
- Cardiology
- Endoscopy
Background:
- Updated guidelines in 2012 addressed antithrombotic therapy during endoscopic procedures.
- Colonoscopic polypectomy carries a significant risk of bleeding.
Purpose of the Study:
- To evaluate the safety of colonoscopic polypectomy in patients on antithrombotic therapy.
- Assessed the bleeding risk associated with continuing or discontinuing antithrombotic medication.
Main Methods:
- Prospective observational study in a tertiary cardiovascular hospital.
- Collected data on 94 patients undergoing 167 polypectomies between July 2018 and July 2019.
- Recorded patient demographics, comorbidities, polyp characteristics, resection methods, and antithrombotic management (discontinuation vs. continuation).
Main Results:
- No significant difference in bleeding rates between patients who discontinued antithrombotic medication and those who continued.
- Age, gender distribution, and bleeding rates were comparable between the two groups (P > 0.05).
Conclusions:
- Colonoscopic polypectomy can be performed without discontinuing antithrombotic medication.
- The procedure is safe for patients with an international normalized ratio (INR) below 2.5 when performed by experienced endoscopists.
Background:
In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding.
Objectives:
The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy.
Design And Setting:
Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey.
Methods:
Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded.
Results:
The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05).
Conclusion:
This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.
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