1
|
Kobayashi S, Harada K, Nawa T, Fujisawa T, Ueki T, Nasu J, Morito Y, Toyokawa T, Inaba T, Kita M, Takenaka R, Inoue M, Higashi R, Tsuduki T, Matsubara M, Yamasaki Y, Okada H, Otsuka M. Bleeding Risk During Colorectal Endoscopic Mucosal Resection With Continued Anticoagulant Therapy: A Multicenter Study. Cureus 2025; 17:e76753. [PMID: 39897323 PMCID: PMC11785420 DOI: 10.7759/cureus.76753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2024] [Indexed: 02/04/2025] Open
Abstract
Background and aims Endoscopic mucosal resection (EMR) is a standard preventive method for colorectal cancer. Managing patients on anticoagulants during EMR is challenging because of balancing bleeding and thrombotic risks. Updated guidelines recommend continuing anticoagulants over heparin bridging; however, data on bleeding risks with continuing anticoagulants remain limited. This multicenter prospective study evaluated bleeding rates in patients who continued oral anticoagulants during EMR. Methods Patients on warfarin or direct oral anticoagulants (DOACs) undergoing EMR were enrolled from 12 tertiary hospitals. Warfarin was maintained on the day of EMR, while DOACs were paused on the day of EMR and resumed afterward. Post-EMR mucosal defects were closed with clips per protocol. Adverse events were monitored for 30 days. The primary endpoint was the major bleeding rate, defined as immediate bleeding requiring difficult hemostasis or delayed bleeding necessitating endoscopic intervention. The secondary endpoints were minor bleeding, other adverse events, and differences in bleeding rates between warfarin and DOACs. Results Among 107 patients (341 polyps; mean size = 6.7 mm), major bleeding occurred in five (4.7%) patients (95% confidence interval: 2.0%-10.5%), and all cases were managed endoscopically. Minor bleeding and thromboembolism events occurred in eight (7.5%) patients and one (0.9%) patient, respectively. No significant differences in bleeding rates were observed between warfarin and DOACs. Major bleeding rates were lower than those reported for heparin bridging. Conclusions Continuing anticoagulant therapy during EMR was associated with a low major bleeding rate (4.7%) and minimal thrombotic events, supporting its safety as an alternative to heparin bridging.
Collapse
Affiliation(s)
- Sayo Kobayashi
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, JPN
| | - Keita Harada
- Department of Gastroenterology, Okayama University Hospital, Okayama, JPN
- Department of Gastroenterology, Okayama Saiseikai General Hospital, Okayama, JPN
| | - Toru Nawa
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, JPN
| | - Tomoo Fujisawa
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, JPN
| | - Toru Ueki
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, JPN
| | - Junichiro Nasu
- Department of Gastroenterology, Okayama Saiseikai General Hospital, Okayama, JPN
| | - Yuki Morito
- Department of Internal Medicine, Mitoyo General Hospital, Kanonji, JPN
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JPN
| | - Tatsuya Toyokawa
- Department of Gastroenterology, Fukuyama Medical Center, Fukuyama, JPN
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, JPN
| | - Masahide Kita
- Department of Gastroenterology, Okayama City Civic Hospital, Okayama, JPN
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama, JPN
| | - Masafumi Inoue
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, JPN
| | - Reiji Higashi
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, JPN
- Department of Gastroenterology, Ichinomiya Nishi Hospital, Ichinomiya, JPN
| | - Takao Tsuduki
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, JPN
| | - Minoru Matsubara
- Department of Gastroenterology, Sumitomo Besshi Hospital, Niihama, JPN
| | - Yasushi Yamasaki
- Department of Gastroenterology, Okayama University Hospital, Okayama, JPN
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Okayama, JPN
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, JPN
| | - Motoyuki Otsuka
- Department of Gastroenterology, Okayama University Hospital, Okayama, JPN
| |
Collapse
|
2
|
Yeh JH, Wang WL, Lin CW, Lee CT, Tseng CH, Hsiao PJ, Liu YP, Wang JY. Safety of cold snare polypectomy with periprocedural antithrombotic agents for colorectal polyps: a systematic review and meta-analysis. Therap Adv Gastroenterol 2022; 15:17562848211070717. [PMID: 35173801 PMCID: PMC8841916 DOI: 10.1177/17562848211070717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/13/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We aimed to study the safety of cold snare polypectomy (CSP) for colorectal polyps in patients administered periprocedural antithrombotic agents. METHODS We searched the PubMed, Embase, and Cochrane Library databases through June 2021. The primary outcomes were the rates of delayed and immediate bleeding (requiring endoscopic hemostasis). Secondary outcomes included thromboembolic events. Meta-analysis using odds ratios (ORs) and corresponding 95% confidence intervals (CIs) was performed to compare the outcomes. RESULTS Seventeen studies, including five randomized trials, were included. Over 96% of polyps were ⩽1 cm. The pooled rates of delayed and immediate bleeding for patients receiving CSP and periprocedural antithrombotic agents were 1.6% and 10.5%, respectively. Both the delayed (OR = 4.02, 95% CI = 1.98-8.17) and immediate bleeding (OR = 5.85, 95% CI = 3.84-8.89) rates were significantly higher in patients using periprocedural antithrombotic agents than in non-users. Although both antiplatelet agents and anticoagulants increased the risk of delayed bleeding, the risks associated with the use of direct oral anticoagulants (DOACs; 2.5%) or multiple agents (3.9%) were particularly high. Compared to their counterparts, diminutive polyps and uncomplicated lesions not requiring hemoclipping were associated with lower risks of delayed bleeding (pooled estimates of 0.4% and 0.18%, respectively). Thromboembolic risk was similar among patients using and not using periprocedural antithrombotic agents. CONCLUSIONS CSP with periprocedural antiplatelet agents and warfarin may be feasible, especially for diminutive polyps. However, drug discontinuation should be considered with the use of DOACs or multiple agents which entail higher bleeding risk even with hemoclipping.
Collapse
Affiliation(s)
- Jen-Hao Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital, Kaohsiung
- Department of Medical Technology, College of Medicine, I-Shou University, Kaohsiung
- Division of Gastroenterology and Hepatology
- Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung
| | - Wen-Lun Wang
- Division of Gastroenterology and Hepatology
- Department of Internal Medicine, E-DA Hospital, Kaohsiung
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung
| | - Chih-Wen Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital, Kaohsiung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung
| | - Ching-Tai Lee
- Division of Gastroenterology and Hepatology
- Department of Internal Medicine, E-DA Hospital, Kaohsiung
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung
| | - Cheng-Hao Tseng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital, Kaohsiung
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Cancer Hospital, Kaohsiung
| | - Po-Jen Hsiao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung
| | - Yu-Peng Liu
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung
| | - Jaw-Yuan Wang
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University
- Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung 807
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung
- Cohort Research Center, Kaohsiung Medical University, Kaohsiung
- Pingtung Hospital, Ministry of Health and Welfare, Pingtung 90054, Taiwan
| |
Collapse
|
3
|
Kobayashi T, Takeuchi M, Hojo Y, Ishii Y, Koseki Y, Kobayashi Y, Azumi M, Kobayashi Y, Kohisa J, Yoshikawa S, Terai S. Risk of delayed bleeding after hot snare polypectomy and endoscopic mucosal resection in the colorectum with continuation of anticoagulants. J Gastrointest Oncol 2021; 12:1518-1530. [PMID: 34532107 DOI: 10.21037/jgo-21-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Current guidelines recommend the temporary discontinuation of anticoagulants before colonoscopic polypectomy, but the effect of this practice on reducing the risk of delayed bleeding after hot snare polypectomy (HSP) and endoscopic mucosal resection (EMR) remains unclear. Our aim was to assess the impact of anticoagulants on the risk of colorectal delayed bleeding after HSP and EMR, and evaluate the necessity of drug withdrawal. Methods We reviewed the clinical data of patients with colorectal polyps using antithrombotic drugs who underwent HSP and/or EMR between January 2016 and September 2020 at Nagaoka Red Cross Hospital. After excluding antiplatelet users, patients were classified into those who continued anticoagulants [continuation group: 50 patients (93 lesions)] and those who discontinued anticoagulants [discontinuation group: 87 patients (190 lesions)]. Results Delayed bleeding occurred in 12 lesions, and there was no significant difference in the incidence rates between the continuation and the discontinuation groups (3.2% vs. 4.7%; P=0.756). Logistic regression analysis showed that continued use of anticoagulants was not a significant risk factor for delayed bleeding compared to anticoagulant discontinuation (odds ratio, 0.670; 95% CI, 0.177-2.537; P=0.556). There was no significant difference in the incidence rate and risk of delayed bleeding, regardless of the length of the anticoagulant withdrawal period. Conclusions Continued use of anticoagulants, compared to their discontinuation, did not increase the risk of colorectal delayed bleeding after HSP and EMR. Our results suggest that current guideline recommendations for anticoagulant withdrawal before colonoscopic polypectomy may be reconsidered. Trial Registration UMIN000040449.
Collapse
Affiliation(s)
- Takamasa Kobayashi
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Manabu Takeuchi
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Yuki Hojo
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Yui Ishii
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Youhei Koseki
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Yoko Kobayashi
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Motoi Azumi
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Yuji Kobayashi
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Junji Kohisa
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Seiichi Yoshikawa
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
4
|
Harada H, Miyaoka Y, Yuki T, Iwaki T, Maeda G, Nakahara R, Murakami D, Ujihara T, Katsuyama Y, Hayasaka K, Kushiyama Y, Fujishiro H, Amano Y. Postpolypectomy bleeding of colorectal polyps in patients with continuous warfarin and short-term interruption of direct oral anticoagulants. Gastrointest Endosc 2021; 93:691-698. [PMID: 33022270 DOI: 10.1016/j.gie.2020.09.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Postpolypectomy bleeding (PPB) is the most common adverse event after colorectal polypectomy. Use of anticoagulants is an important risk factor for PPB. This study aimed to evaluate PPB in patients receiving treatment with warfarin and direct oral anticoagulants (DOACs). METHODS Between August 2017 and July 2019, 5449 patients with 12,601 polyps who underwent endoscopic snare resection of colorectal polyps were enrolled. Endoscopic snare resection was performed in patients receiving continuous warfarin (C-warfarin) and in patients who experienced 1 day cessation of (O-) of DOACs in accordance with the Japanese Gastroenterological Endoscopy Society guidelines. RESULTS The PPB rate in the group receiving anticoagulants was statistically higher than that in the group without anticoagulants (8.5% [33/387] vs 1.2% [63/5,062], respectively; P < .001). By multivariate logistic regression analysis, male gender (odds ratio [OR], 2.17; P = .007), warfarin (OR, 4.64; P < .001), DOACs (OR, 6.59; P < .001), and multipolyp removal (OR, 1.77; P = .007) were significant risk factors for PPB. PPB was observed in 9 and 21 patients in the C-warfarin and O-DOACs groups, respectively: C-warfarin (8.0% [9/113]), O-dabigatran (6.1% [2/33]), O-rivaroxaban (14.8% [9/61]), O-apixaban (9.8% [9/92]), and O-edoxaban (1.8% [1/56]). The PPB rate with the O-edoxaban group was significantly lower than that with the O-rivaroxaban group (P < .05). CONCLUSIONS Use of anticoagulant therapy was an independent risk factor for PPB. The rates of PPB in patients receiving C-warfarin and O-DOACs were also higher than those in patients not receiving anticoagulants. Edoxaban may be safe through short-term withdrawal in patients undergoing endoscopic snare resection of colorectal polyps.
Collapse
Affiliation(s)
- Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Youichi Miyaoka
- Department of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Takafumi Yuki
- Department of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Tomoyuki Iwaki
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Gen Maeda
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Ryotaro Nakahara
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Daisuke Murakami
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Tetsuro Ujihara
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | | | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | | | - Hirofumi Fujishiro
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, Chiba, Japan
| |
Collapse
|
5
|
Xiang BJ, Huang YH, Jiang M, Dai C. Effects of antithrombotic agents on post-operative bleeding after endoscopic resection of gastrointestinal neoplasms and polyps: A systematic review and meta-analysis. World J Meta-Anal 2020; 8:410-433. [DOI: 10.13105/wjma.v8.i5.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
6
|
Xiang BJ, Huang YH, Jiang M, Dai C. Effects of antithrombotic agents on post-operative bleeding after endoscopic resection of gastrointestinal neoplasms and polyps: A systematic review and meta-analysis. World J Meta-Anal 2020; 8:411-434. [DOI: 10.13105/wjma.v8.i5.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/07/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
|
7
|
Won Ma D, Kim JS, Ji JS, Kim BW, Choi H. Cold Snare Polypectomy in Patients Taking Dual Antiplatelet Therapy: A Randomized Trial of Discontinuation of Thienopyridines. Clin Transl Gastroenterol 2019; 10:e00091. [PMID: 31599746 PMCID: PMC6884347 DOI: 10.14309/ctg.0000000000000091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/20/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Cold snare polypectomy (CSP) is a safe and effective method for removing polyps ≤10 mm. The aim of this study was to compare the risk of clinically significant bleeding and thromboembolic events after CSP between stopping and continuing thienopyridines in patients taking dual antiplatelet therapy (DAPT). METHODS The study was a single-center, noninferiority, and randomized controlled study involving patients who received colonoscopy from October 2015 to October 2016. Patients receiving DAPT with polyps ≤10 mm were randomly assigned to either the DAPT group (patients continued DAPT) or the aspirin group (patients discontinued thienopyridines for 1 week). Primary outcome was clinically significant bleeding. Secondary outcomes included intraprocedural bleeding, nonsignificant hematochezia, and occurrence of thromboembolic events. RESULTS Forty-two patients with 104 eligible polyps were allocated to the DAPT group, and 45 patients with 101 eligible polyps were allocated to the aspirin group. Patient demographic characteristics including size, location, shape, and pathology of the removed polyps were similar in the 2 groups. Intraprocedural bleeding and nonsignificant hematochezia rates were also similar between the 2 groups (4.8% vs 2.2%, P = 0.608; 19.0% vs 8.9%, P = 0.170). No thromboembolic event occurred in either group. Only 1 patient (2.4%) in the DAPT group showed clinically significant bleeding. No significant bleeding was found in the aspirin group. DISCUSSION Clinically significant bleeding rate after CSP for polyps ≤10 mm in patients continuing to take DAPT was 2.4%. Therefore, CSP is a safe method for removing small polyps even in patients taking DAPT (ClincialTrials.gov number, NCT02865824).
Collapse
Affiliation(s)
- Dae Won Ma
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jeong-Seon Ji
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hwang Choi
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| |
Collapse
|
8
|
Gutta A, Gromski MA. Endoscopic Management of Post-Polypectomy Bleeding. Clin Endosc 2019; 53:302-310. [PMID: 31525836 PMCID: PMC7280838 DOI: 10.5946/ce.2019.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/18/2019] [Indexed: 12/11/2022] Open
Abstract
Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.
Collapse
Affiliation(s)
- Aditya Gutta
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark A Gromski
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
9
|
Sakai T, Nagami Y, Shiba M, Hayashi K, Kinoshita Y, Maruyama H, Kato K, Minamino H, Ominami M, Fukunaga S, Otani K, Hosomi S, Tanaka F, Taira K, Kamata N, Yamagami H, Tanigawa T, Watanabe T, Fujiwara Y. Heparin-bridging therapy is associated with post-colorectal polypectomy bleeding in patients whose oral anticoagulation therapy is interrupted. Scand J Gastroenterol 2019; 53:1304-1310. [PMID: 30345853 DOI: 10.1080/00365521.2018.1503325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The American and Japanese Societies for Gastrointestinal Endoscopy Guidelines recommend heparin-bridging therapy for patients whose oral anticoagulants are interrupted for endoscopic procedures. However, little is known about the potential association between heparin-bridging therapy and post-polypectomy bleeding (PPB). The aim was to investigate the incidence of PPB associated with heparin-bridging therapy administered to patients whose anticoagulants were interrupted. MATERIALS AND METHODS This was a retrospective observational study using inverse propensity analysis. Between 2013 and 2015, 1004 patients with 2863 lesions were included. The primary outcomes were the rates of PPB and thromboembolism associated with heparin-bridging therapy. The risk factors associated with PPB were identified using multivariate logistic regression analysis involving probability of treatment weighting (IPTW). RESULTS The patients were categorized into a heparin-bridging therapy group (78 patients with 255 lesions) or a control group (926 patients with 2608 lesions). The PPB rate in the heparin-bridging therapy group (10.2%, 8/78) was significantly higher than in the control group (1.1%, 11/926) (p <.01). Thromboembolism occurred in one patient in the control group. The multivariate analysis revealed that heparin-bridging therapy was an independent risk factor associated with PPB (odds ratio [OR], 8.21; 95% confidence interval [95% CI], 2.32-29.10; p <.01). IPTW showed heparin-bridging therapy increased PPB (OR, 7.68; 95% CI, 1.83-32.28; p <.01). CONCLUSIONS Heparin-bridging therapy administered to patients whose oral anticoagulants were interrupted was associated with an increased PPB risk.
Collapse
Affiliation(s)
- Taishi Sakai
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Yasuaki Nagami
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Masatsugu Shiba
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Kappei Hayashi
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Yosuke Kinoshita
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Hirotsugu Maruyama
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Kunihiro Kato
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Hiroaki Minamino
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Masaki Ominami
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Shusei Fukunaga
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Koji Otani
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Shuhei Hosomi
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Fumio Tanaka
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Koichi Taira
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Noriko Kamata
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Hirokazu Yamagami
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Tetsuya Tanigawa
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Toshio Watanabe
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Yasuhiro Fujiwara
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| |
Collapse
|
10
|
Ciocalteu A, Gheonea DI, Saftoiu A, Streba L, Dragoescu NA, Tenea-Cojan TS. Current strategies for malignant pedunculated colorectal polyps. World J Gastrointest Oncol 2018; 10:465-475. [PMID: 30595800 PMCID: PMC6304302 DOI: 10.4251/wjgo.v10.i12.465] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 02/05/2023] Open
Abstract
Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate staging remain the main factors that lead to a decrease in the cost and invasiveness of the curative techniques, significantly improving the outcome. However, the diagnosis of pedunculated early colorectal malignancy remains a current challenge. Data on the management of pedunculated cancer precursors, apart from data on nonpolypoid lesions, are still limited. An adequate technique for complete resection, which provides the best long-term outcome, is mandatory for curative intent. In this context, a discussion regarding the diagnosis of malignancy of pedunculated polyps, separate from non-pedunculated variants, is necessary. The purpose of this review is to provide a critical review of the most recent literature reporting the different features of malignant pedunculated colorectal polyps, including diagnosis and management strategies.
Collapse
Affiliation(s)
- Adriana Ciocalteu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Dan Ionut Gheonea
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Liliana Streba
- Department of Oncology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Nicoleta Alice Dragoescu
- Department of Anesthesiology and Intensive Care, Emergency County Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Tiberiu Stefanita Tenea-Cojan
- Department of General Surgery, C.F. Clinical Hospital, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| |
Collapse
|