Colonoscopy with polypectomy in anticoagulated patients - PubMed (original) (raw)
Colonoscopy with polypectomy in anticoagulated patients
Shai Friedland et al. Gastrointest Endosc. 2006 Jul.
Abstract
Background: According to current practice guidelines for performance of colonoscopy in patients requiring long-term anticoagulation, polypectomy is considered a high-risk procedure for which anticoagulation must temporarily be discontinued. However, these guidelines are based on expert opinion, and the bleeding risk after polypectomy in anticoagulated patients is not known.
Objective: Measure the risk of postpolypectomy bleeding in patients who undergo colonoscopic polypectomy while anticoagulated.
Design: Retrospective review of patients who underwent polypectomy without discontinuation of anticoagulation.
Setting: Veterans Administration Palo Alto Health Care System.
Patients: Forty-one polypectomies were performed in 21 patients. All patients had been receiving long-term anticoagulation with warfarin; the average international normalized ratio was 2.3 (range 1.4-4.9; normal 0.9-1.2). To prevent supratherapeutic anticoagulation, warfarin was withheld for 36 hours before the procedure while the patients were on a liquid diet. The average polyp size was 5 mm (range 3-10 mm).
Interventions: All patients underwent polypectomy followed immediately by prophylactic application of one or two clips to prevent bleeding.
Main outcome measurements: Rate of postpolypectomy bleeding.
Results: There were no episodes of postpolypectomy bleeding. The 95% CI for the risk of bleeding was 0% to 8.6% when analyzed per polypectomy and 0% to 15% when analyzed per patient.
Limitations: Small single-center retrospective study.
Conclusions: Our experience suggests that small polyps can be removed with a very low risk of bleeding when clips are applied immediately after polypectomy. If these results can be confirmed in a larger multicenter study, our protocol may become an alternative to withholding anticoagulation in patients at high risk of thrombosis.
Comment in
- Prophylactic clip application should be the standard of care to prevent postpolypectomy bleeding.
Nagri S, Anand S. Nagri S, et al. Gastrointest Endosc. 2007 Jan;65(1):182; author reply 183. doi: 10.1016/j.gie.2006.07.018. Gastrointest Endosc. 2007. PMID: 17185107 No abstract available. - Prophylactic clip application after colonic polypectomy.
Harewood GC. Harewood GC. Gastrointest Endosc. 2007 Jan;65(1):183; author reply 183. doi: 10.1016/j.gie.2006.07.039. Gastrointest Endosc. 2007. PMID: 17185109 No abstract available.
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