Background and Aims

Balancing the risks for thromboembolism and postpolypectomy bleeding in patients requiring anticoagulation and antiplatelet agents is challenging. We investigated the incidence and risk factors for postpolypectomy bleeding on anticoagulation, including heparin bridge and other antithrombotic therapy.

Methods

We performed a retrospective cohort and case control study at 2 tertiary-care medical centers from 2004 to 2012. Cases included male patients on antithrombotics with hematochezia after polypectomy. Nonbleeding controls were matched to cases 3 to 1 by antithrombotic type, study site, polypectomy technique, and year of procedure. Our outcomes were the incidence and risk factors for postpolypectomy bleeding.

Results

There were 59 cases and 174 matched controls. Postpolypectomy bleeding occurred in 14.9% on bridge anticoagulation. This was significantly higher than the overall incidence of bleeding on antithrombotics at 1.19% (95% confidence interval, 0.91%-1.54%) (59/4923). We identified similarly low rates of bleeding in patients taking warfarin (0.66%), clopidogrel (0.84%), and aspirin (0.92%). Patients who bled tended to have larger polyps (13.9 vs 7.3 mm; P < .001) and more polyps ≥2 cm (41% vs 10%; P < .001). Bleeding risk was increased with restarting antithrombotics within 1 week postpolypectomy (odds ratio [OR] 4.50; P < .001), having polyps ≥2 cm (OR 5.94; P < .001), performing right-sided cautery (OR 2.61; P = .004), and having multiple large polyps (OR 2.92; P = .001). Among patients on warfarin, the presence of bridge anticoagulation was an independent risk factor for postpolypectomy bleeding (OR 12.27; P = .0001).

Conclusion

We conclude that bridge anticoagulation is associated with a high incidence of postpolypectomy bleeding and is an independent risk factor for hemorrhage compared with patients taking warfarin alone. A higher threshold to use bridge anticoagulation should be considered in patients with an elevated bleeding risk.

中文翻译：

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接受抗凝或抗血小板药物的患者息肉切除术后出血的危险因素

背景和目标

在需要抗凝和抗血小板药物的患者之间平衡血栓栓塞和息肉切除术后出血的风险具有挑战性。我们调查了抗凝治疗息肉切除术后出血的发生率和危险因素，包括肝素桥和其他抗血栓治疗。

方法

我们从2004年至2012年在两个三级医疗中心进行了一项回顾性队列研究和病例对照研究。病例包括息肉切除术后服用抗血栓药的男性患者。通过抗血栓类型，研究部位，息肉切除术技术和手术年份，将非出血对照与3至1例患者进行匹配。我们的结果是息肉切除术后出血的发生率和危险因素。

结果

有59例病例和174个匹配的对照。息肉切除术后出血的发生率为桥抗凝的14.9％。这显着高于抗血栓形成剂的总出血发生率1.19％（95％置信区间，0.91％-1.54％）（59/4923）。我们发现服用华法令（0.66％），氯吡格雷（0.84％）和阿司匹林（0.92％）的患者出血率相似。出血患者倾向于有较大的息肉（13.9 vs 7.3 mm；P  <.001）和更多的息肉≥2 cm（41％vs 10％；P  <.001）。息肉切除术后1周内重新开始使用抗栓剂会增加出血风险（比值[OR] 4.50；P  <.001），息肉≥2 cm（OR 5.94；P  <.001），进行右侧烧灼（OR 2.61；P） = .004），并有多个大息肉（OR 2.92；P  = .001）。在使用华法令的患者中，桥抗凝的存在是息肉切除术后出血的独立危险因素（OR 12.27；P  = .0001）。

结论

我们得出的结论是，与单独服用华法林的患者相比，桥抗凝治疗与息肉切除术后出血的高发生率相关，并且是出血的独立危险因素。对于出血风险较高的患者，应考虑使用桥抗凝的较高阈值。