The risk of post-polypectomy bleeding among patients receiving antithrombotic agents: A prospective observational study

ABSTRACT BACKGROUND: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding. OBJECTIVES: The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy. DESIGN AND SETTING: Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey. METHODS: Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients’ data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded. RESULTS: The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05). CONCLUSION: This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.【背景】2012年7月，日本胃肠内镜学会（Japan Gastroenterological Endoscopy Society）更新了针对接受抗血栓治疗（antithrombotic therapy）患者的胃肠内镜诊疗指南。结肠镜下息肉切除术（colonoscopic polypectomy）存在较高的出血风险。 【目的】本研究旨在评估接受抗血栓治疗的患者行结肠镜下息肉切除术的出血相关安全性。 【研究设计与地点】本研究为前瞻性观察性研究，在土耳其伊斯坦布尔的一所三级公立心血管专科医院开展。 【方法】前瞻性分析2018年7月至2019年7月期间，单一内镜中心完成的所有结肠镜下息肉切除术病例。收集患者的基线数据，包括年龄、性别、合并症、是否停用抗血栓药物或换用桥接治疗（bridging therapy）、息肉大小、息肉类型、息肉位置、组织病理学（histopathology）结果、切除方式（热圈套器、冷圈套器或活检钳）以及手术相关并发症等信息。 【结果】本研究最终纳入94例患者，共计完成167例次息肉切除术。根据抗血栓药物处方医师的指导，60例患者未停用抗血栓药物，共实施108例次手术；34例患者停用抗血栓药物，共实施59例次手术。停药组与持续用药组患者的年龄、性别分布及出血发生率均无显著统计学差异（P > 0.05）。 【结论】本研究表明，未停用抗血栓药物的结肠镜下息肉切除术并未增加出血风险。对于国际标准化比值（international normalized ratio, INR）低于2.5的患者，经验丰富的内镜医师可安全开展该手术。