Heparin bridge therapy and post-polypectomy bleeding

Table 1 Prescription of antithrombotic agents

Anticoagulants	n
Warfarin	68
Dabigatran	12
Rivaroxaban	3
Antiplatelets
Aspirin	93
Clopidogrel	35
Cilostazol	31
Ticlopidine	12
Others	28
Anticoagulants + antiplatelets	28
Dual antiplatelets	59
Triple antiplatelets	8
Heparin bridge	73

Table 2 Characteristics of the study cohort and polyps n (%)

		No bleeding	Bleeding	P value
No. of patients		759 (96.3)	29 (3.7)
Age (yr, mean)		64 ± 14.3	62 ± 16.0	0.50
Gender	Male	458 (98.1)	9 (1.9)	0.35
	Female	301 (93.8)	20 (6.2)
Polyp location	Right	239 (95.6)	11 (4.4)	0.93
	Left	336 (95.5)	16 (4.5)
Polyp size	≥ 10 mm	338 (96.8)	11 (3.2)	0.43
	< 10 mm	361 (95.8)	16 (4.2)
Polyp shape	Flat	266 (96.7)	9 (3.3)	0.73
	Sessile	416 (96.5)	15 (3.5)
	Pedunculated	118 (95.2)	6 (4.8)
No. of polyps resected	1	343 (96.6)	12 (3.4)	0.69
	≥ 2	416 (96.1)	17 (3.9)
Prophylactic clipping	Yes	566 (95.8)	25 (4.2)	0.16
	No	193 (98.0)	4 (2.0)
Resection method	Polypectomy or EMR	703 (96.6)	25 (3.4)	0.20
	ESD	56 (93.3)	4 (6.7)
Antiplatelets	Yes	146 (94.8)	8 (5.2)	0.27
	No	613 (96.7)	21 (3.3)
Anticoagulants	Yes	72 (86.7)	11 (13.3)	< 0.001
	No	687 (97.4)	18 (2.6)
Heparin bridge	Yes	63 (86.3)	10 (13.7)	< 0.001
	No	696 (97.3)	19 (2.7)
Antiplatelets + heparin bridge	Yes	32 (91.4)	3 (8.6)	0.11
	No	727 (96.5)	26 (3.5)
Anticoagulants + heparin bridge	Yes	47 (82.5)	10 (17.5)	< 0.001
	No	712 (97.4)	19 (2.6)

PPB: Post-polypectomy bleeding.

Table 3 Multivariate analysis of risk factors for Post-polypectomy bleeding

Variable	Odds ratio	95%CI	P value
Anticoagulants	4.227	1.126-15.872	0.033
Heparin bridge therapy	2.172	0.556-8.482	0.265
Anticoagulants+ heparin bridge	9.796	3.771-25.443	< 0.001

PPB: Post-polypectomy bleeding.

Table 4 Summary of 11 post-polypectomy bleeding cases taking anticoagulants

	Anticoagu-lants	Antiplatelets	Heparin	Onset of	PT-INR	Anticoagulants	APTT	Heparin
			bridge	PPB (POD)	at PPB	at PPB	at PPB	at PPB
1	Warfarin	Clopidogrel	Yes	5	1.62	Yes	93.1	Yes
2	Warfarin	-	Yes	2	1.31	Yes	42.8	Yes
3	Warfarin	-	Yes	6	1.26	Yes	32.2	No
4	Warfarin	Aspirin	Yes	2, 5	1.20	Yes	29.4	Yes
5	Warfarin	-	Yes	5	1.25	Yes	73.1	Yes
6	Dabigatran	-	No	2	2.03	-	-	-
7	Warfarin	-	Yes	1, 2	1.31	No	45.2	Yes
8	Dabigatran	-	Yes	6	1.40	-	50.1	No
9	Warfarin	-	Yes	1, 6	1.23	No	33.5	Yes
10	Warfarin	Aspirin	Yes	2	1.32	Yes	40.4	Yes
		(Continued)
11	Warfarin	-	Yes	1	1.21	Yes	29.5	Yes

PPB: Post-polypectomy bleeding; POD: Post-operative day.