Systematic review with meta-analysis: the risk of gastrointestinal haemorrhage post-polypectomy in patients receiving anti-platelet, anti-coagulant and/or thienopyridine medications.

Abstract

BACKGROUND:

For patients undergoing colonoscopy with polypectomy, current guidelines recommend temporary cessation of blood-thinning medications. The data regarding periprocedural management of these medications are sparse.

AIM:

To perform a systematic review and meta-analysis to determine the risk of post-polypectomy bleeding (PPB) in patients taking anti-platelet, anti-coagulant and/or thienopyridine medications.

METHODS:

We searched Pubmed, Scopus, Web of Science, Biosis and Proceedings First from 1970 to 2015. PPB was defined as overt haemorrhage or drop in haemoglobin of at least 2 g/dL.

RESULTS:

Of 1490 articles identified, we included 3 papers and 1 abstract with patients on aspirin and/or NSAIDs, 1 paper on warfarin, 2 abstracts on clopidogrel, and 2 papers on clopidogrel plus aspirin and/or NSAIDs. While the rate of immediate PPB on aspirin and/or NSAIDs was not increased (OR = 1.1, 95% CI 0.7-1.9, P = 0.7), the risk of delayed PPB was increased (OR = 1.7, 95% CI 1.0-2.4, P = 0.0009, I(2)  = 60%) but rendered non-significant with elimination of a small study. There was an elevated risk of delayed PPB on clopidogrel (OR = 9.7, 95% CI 3.1-30.8, P = 0.0, I(2)  = 0). There was an increased risk of delayed PPB in patients on clopidogrel + aspirin and/or NSAIDs (OR = 3.4, 95% CI 1.3-8.8, P = 0.01, I(2)  = 0). Based on a single study on warfarin, the PPB rate was elevated. There were no data regarding PPB and usage of the newer anti-coagulant agents.

CONCLUSIONS:

Usage of aspirin or NSAIDs does not increase risk of post-polypectomy bleeding. Clopidogrel and warfarin should be discontinued in the periprocedural period to prevent the occurrence of post-polypectomy bleeding.

• Authors: D Shalman, L B Gerson
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 42 Issue 8 Pg. 949-56 (Oct 2015) ISSN: 1365-2036 [Electronic] England
• PMID: 26290157 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: © 2015 John Wiley & Sons Ltd.

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Anticoagulants
• Platelet Aggregation Inhibitors
• Pyridines
• thienopyridine
• Warfarin
• Aspirin

Topics

• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Anticoagulants (administration & dosage, adverse effects, therapeutic use)
• Aspirin (therapeutic use)
• Blood Coagulation Disorders (complications, drug therapy, epidemiology, surgery)
• Colonic Polyps (complications, epidemiology, surgery)
• Colonoscopy (adverse effects)
• Gastrointestinal Hemorrhage (epidemiology, etiology)
• Humans
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Pyridines (administration & dosage, adverse effects, therapeutic use)
• Risk Factors
• Warfarin (therapeutic use)