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International Journal of Colorectal Disease

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01-10-2019 | Anticoagulant | Original Article

Post-polypectomy bleeding in hot-snare polypectomy of colonic polyps under continued warfarin or short interruption of direct oral anticoagulants

Authors: Yuichi Shimodate, Masayuki Ueno, Tomohiko Sunami, Hiroshi Takayama, Rio Takezawa, Akira Doi, Naoyuki Nishimura, Hirokazu Mouri, Kazuhiro Matsueda, Hiroshi Yamamoto, Motowo Mizuno

Published in: International Journal of Colorectal Disease | Issue 10/2019

Abstract

Background

Newly published guidelines of the Japanese Gastroenterological Endoscopy Society (JGES) suggest to consider endoscopic procedures with high risk of bleeding without stopping warfarin and with stopping direct oral anticoagulants (DOACs) only on the day of the procedure. In this study, we aimed to test the validity of these recommendations.

Patients and methods

We retrospectively reviewed medical records of 344 patients with anticoagulant therapy who underwent hot-snare polypectomy between January 2012 and October 2018. Patients (n = 132) with interruption of anticoagulants (3–7 days for warfarin and 2–3 days for DOACs before the procedure) and without heparin-bridging were excluded. Among the remaining 212 patients, the incidence of post-polypectomy bleeding was compared between the following 2 patient groups: patients who had interruption of anticoagulants with heparin-bridging (HB group, n = 139) and patients treated according to the new JGES guideline (FG group, n = 73).

Results

The rate of post-polypectomy bleeding (PPB) in FG group (9.6%) was not significantly different from that in HB group (12.9%, p = 0.5). In subgroup analysis, the incidence of bleeding in patients with warfarin (12.2%) and with DOAC (6.3%) in FG group was not significantly different from corresponding figures in HB group (14.2%, 0%). In multivariate analysis, number of resected polyps was associated with PPB, but the administration of anticoagulants according to the new guidelines was not a significant risk factor for PPB (p = .98).

Conclusions

Our study affirms the recommendations of JGES for the management of anticoagulants in patients who undergo colonic polypectomy regarding post-polypectomy bleeding.

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Title: Post-polypectomy bleeding in hot-snare polypectomy of colonic polyps under continued warfarin or short interruption of direct oral anticoagulants
Authors: Yuichi Shimodate
Masayuki Ueno
Tomohiko Sunami
Hiroshi Takayama
Rio Takezawa
Akira Doi
Naoyuki Nishimura
Hirokazu Mouri
Kazuhiro Matsueda
Hiroshi Yamamoto
Motowo Mizuno
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Keywords: Anticoagulant
Direct Oral Anticoagulant
Warfarin
Direct Oral Anticoagulant
Heparin
Published in: International Journal of Colorectal Disease / Issue 10/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03373-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Post-polypectomy bleeding in hot-snare polypectomy of colonic polyps under continued warfarin or short interruption of direct oral anticoagulants

Abstract

Background

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusions

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