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Post-polypectomy Bleeding and Thromboembolism Risks Associated With Warfarin

Post-polypectomy Bleeding and Thromboembolism Risks Associated With Warfarin

Naohiro Yanagisawa, Naoyoshi Nagata, Kazuhiro Watanabe, Tatsuhiro Iida, Mariko Hamada, Sakurako Kobayashi, Takuro Shimbo, Junichi Akiyama, Naomi Uemura

World J Gastroenterol. 2018 Apr 14;24(14):1540-1549.

PMID: 29662292

Abstract:

Aim:
To verify the validity of the endoscopy guidelines for patients taking warfarin or direct oral anticoagulants (DOAC).
Methods:
We 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. (1) We evaluated post-polypectomy bleeding (PPB) risk in patients receiving warfarin or DOAC compared with controls; (2) we assessed the risks of PPB and thromboembolism between three AC management methods: Discontinuing AC with heparin bridge (HPB) (endoscopy guideline recommendation), continuing AC, and discontinuing AC without HPB.
Results:
PPB rate was significantly higher in warfarin users and DOAC users compared with controls (13.7% and 13.7% vs 0.9%, P < 0.001), but was not significantly different between rivaroxaban (13.2%), dabigatran (11.1%), and apixaban (13.3%) users. Two thromboembolic events occurred in warfarin users, but none in DOAC users. Compared with the continuing anticoagulant group, the discontinuing anticoagulant with HPB group (guideline recommendation) had a higher PPB rate (10.8% vs 19.6%, P = 0.087). These findings were significantly evident in warfarin but not DOAC users. One thrombotic event occurred in the discontinuing anticoagulant with HPB group and the discontinuing anticoagulant without HPB group; none occurred in the continuing anticoagulant group.
Conclusion:
PPB risk was similar between patients taking warfarin and DOAC. Thromboembolism was observed in warfarin users only. The guideline recommendations for HPB should be re-considered.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP1800066243	HPB		1800066-24-3	Price

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