Continuation of Anti-thrombotic Therapy may be Associated with a High Incidence of Colonic Post-polypectomy Bleeding

Abstract

Objectives

Post-polypectomy bleeding (PPB) is the most common complication of endoscopic procedures. To reduce the risk of thromboembolic incidents, Japanese guidelines for gastroenterological endoscopy were revised to indicate that antithrombotic agents were not to be discontinued for endoscopic treatment. However, performing endoscopic procedures under antithrombotic medication potentially increases the incidence of hemorrhagic complications. This study investigated the impact of the revised guidelines on the frequency of complications after colonoscopic procedures.

Methods

The surveillance period was comprised of the year before the initiation of the new guidelines (2012), which served as a control period, and 2 years after initiation of the new guidelines (2013 and 2014). During the control period 3955 cases were examined colonoscopically and 1601 lesions were treated endoscopically. During the 2-year period under the new guidelines, 8749 colonoscopies and 3768 endoscopic treatments were performed. Changes in treatment methods and rates of complications were compared.

Results

The PPB rate was not significantly different before and after the revision (0.87% vs 1.01%). With the new guidelines, PPB rates in antithrombotic non-users and users were 0.60% and 3.13%, respectively (OR 5.11, P=0.000). Multivariable analysis showed that the risks for PPB were: Heparin bridging therapy (OR 6.34, P=0.0002), low dose aspirin (LDA) continuation (OR 5.30, P=0.0079), and lesion size (OR 1.06, P<0.0001).

Conclusions

The present study showed that the overall PPB rate under the new guidelines was not significantly higher when compared with the previous data obtained before the new guidelines were introduced.

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