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Periprocedural Anticoagulation Management of Patients Undergoing Colonoscopy with Polypectomy
Melissa Chan1, Joshua Yoon1, Jennifer J Telford1,2,3
1Department of Medicine, University of British Columbia, Vancouver, Canada.
Summary
A new care pathway for managing anticoagulation during colonoscopy with polypectomy resulted in low rates of bleeding and clotting complications. This standardized approach ensures patient safety during colorectal cancer screening.
Area of Science:
- Gastroenterology
- Cardiology
- Oncology
Background:
- Colonoscopy with polypectomy is crucial for colorectal cancer screening.
- Periprocedural anticoagulation management lacks standardized guidelines, posing risks of bleeding or thromboembolism.
- Limited data exists on managing oral anticoagulants during colonoscopies.
Purpose of the Study:
- To evaluate the incidence of bleeding and thromboembolic complications in patients undergoing colonoscopy.
- To assess the effectiveness of a novel patient care pathway for standardized periprocedural anticoagulation management.
- To determine safety outcomes following colonoscopy with polypectomy in patients on oral anticoagulants.
Main Methods:
- Retrospective study of 162 patients (age 50-74) on oral anticoagulants undergoing colonoscopy.
- Inclusion criteria: abnormal fecal immunochemical test, referral to British Columbia Colon Screening Program.
- Primary outcomes: major bleeding and thromboembolic events within 14 days post-colonoscopy.
Main Results:
- One major bleeding event (0.6%) occurred.
- One arterial thromboembolic event (0.6%) occurred.
- The study included patients on vitamin K antagonists and direct oral anticoagulants.
Conclusions:
- A novel, standardized anticoagulation management pathway is associated with low complication rates.
- Multidisciplinary team involvement in the care pathway enhances patient safety.
- This approach effectively balances bleeding and thrombotic risks in anticoagulated patients undergoing colonoscopy.
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