Published online Apr 14, 2018. doi: 10.3748/wjg.v24.i14.1540
Peer-review started: February 21, 2018
First decision: March 9, 2018
Revised: March 15, 2018
Accepted: March 25, 2018
Article in press: March 25, 2018
Published online: April 14, 2018
The number of oral anticoagulants (AC) used increases as the population ages, and the number of colonoscopic polypectomies is expected to increase in patients receiving AC.
Whether post-polypectomy bleeding (PPB) or thromboembolic risk differs between warfarin and direct oral anticoagulant (DOAC) users remains unknown.
We evaluated PPB risk in patients receiving warfarin or DOAC compared with patients not receiving any antithrombotics (controls). We also assessed the risks of PPB and thromboembolism between the three AC management methods mentioned above, discontinuing AC with heparin bridge (guideline recommendation), continuing AC, and discontinuing AC without heparin bridge.
We conducted a retrospective cohort study and collected data from 218 patients receiving oral anticoagulants (73 DOAC users, 145 warfarin users) and 218 patients not receiving any antithrombotics (age- and sex-matched controls) who underwent polypectomy.
PPB rate was significantly higher in both warfarin users and DOAC users compared with controls. Two thromboembolic events occurred in warfarin users, but none in DOAC users. Compared with the continuing anticoagulant group, the discontinuing anticoagulant with heparin bridge group (guideline recommendation) had a higher PPB rate. One thrombotic event occurred in the discontinuing anticoagulant with heparin bridge group and the discontinuing anticoagulant without heparin bridge group; none occurred in the continuing anticoagulant group.
Patients receiving oral anticoagulant had higher risks of bleeding after colonoscopic polypectomy compared with patients not receiving any antithrombotics. PPB risk was similar between warfarin and DOAC users, whereas thromboembolism risk was observed in warfarin users only. Heparin bridge increased bleeding risk, and may not prevent thromboembolism.
The current guideline recommendation for heparin bridge should be re-considered, and continuing oral anticoagulant may be acceptable for polypectomy.