Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy - 24/08/11
Reprint requests: Uma Murthy, MD, 4 W, Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY 13210Résumé |
Background |
The risk of postpolypectomy bleeding (PPB) in patients undergoing colonoscopy on uninterrupted clopidogrel therapy has not been established.
Objective |
To assess the PPB rate and outcome and identify risk factors associated with PPB in patients taking clopidogrel.
Design |
Single-center, retrospective study. Demographics, clinical parameters, polyp characteristics, polypectomy techniques, and postpolypectomy events in the groups were compared by univariate analysis. Stepwise logistic regression analyses identified independent risk factors associated with PPB.
Setting |
Veterans Affairs Medical Center.
Patients |
A total of 142 patients (375 polypectomies) taking clopidogrel (cases) and 1243 patients (3226 polypectomies) not taking clopidogrel (controls).
Interventions |
None.
Main Outcome Measurements |
Postpolypectomy bleeding, hospitalization, and mortality.
Results |
The immediate (intraprocedural) bleeding rate was similar in the 2 groups (2.1% vs 2.1%). Delayed (postprocedural) PPB rate was higher in the group taking clopidogrel (3.5% vs 1.0%, P = .02). Delayed bleeding of significance requiring hospitalization and transfusion/intervention was also higher in patients taking clopidogrel (2.1% vs 0.4%, P = .04). The length of hospital stay and interventions for PPB were comparable between the 2 groups. There was no mortality. Concomitant use of clopidogrel and aspirin/other nonsteroidal anti-inflammatory drugs (odds ratio 3.7; 95% CI, 1.6-8.5) and the number of polyps removed (OR 1.3; 95% CI, 1.2-1.4) were the only significant risk factors associated with PPB. Clopidogrel alone was not an independent risk factor for PPB.
Limitations |
Retrospective study and small number of patients with PPB.
Conclusions |
The PPB rate is significantly higher in patients undergoing polypectomy while taking clopidogrel and concomitant aspirin/nonsteroidal anti-inflammatory drugs; however, the risk is small and the outcome is favorable. Routine cessation of clopidogrel in patients before colonoscopy/polypectomy is not necessary.
Le texte complet de cet article est disponible en PDF.Abbreviations : ASA, CAD, COPD, CrCl, DM, HTN, NSAID, OR, PPB, PPI, VAMC
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| See CME section; p. 1028 |
Vol 71 - N° 6
P. 998-1005 - mai 2010 Retour au numéro
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