Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2016; 22(45): 10009-10014
Published online Dec 7, 2016. doi: 10.3748/wjg.v22.i45.10009
Heparin bridge therapy and post-polypectomy bleeding
Toshiyuki Kubo, Kentaro Yamashita, Kei Onodera, Tomoya Iida, Yoshiaki Arimura, Masanori Nojima, Hiroshi Nakase
Toshiyuki Kubo, Kentaro Yamashita, Kei Onodera, Tomoya Iida, Hiroshi Nakase, Department of Gastroenterology and Hepatology, Sapporo Medical University, Sapporo 0608543, Japan
Yoshiaki Arimura, Department of Gastroenterology, Otaru City General Hospital, Otaru 0478550, Japan
Masanori Nojima, Center for Translational Research, the Institute of Medical Science, the University of Tokyo, Tokyo 1088639, Japan
Author contributions: Kubo T designed the study and collected and analyzed the data; Kubo T and Yamashita K wrote the manuscript; Onodera K and Iida T provided analytical oversight; Arimura Y supervised the study; Nojima M conducted statistical analysis; Nakase H revised the manuscript for important intellectual content; all authors read and approved the final version.
Institutional review board statement: The Institutional Review Board of Sapporo Medical University approved this study.
Informed consent statement: All participants in this study provided their verbal informed consent prior to study enrollment.
Conflict-of-interest statement: The authors disclose no conflicts of interest.
Data sharing statement: The technical appendix, statistical code and dataset are available from the corresponding author at kubo-t@grape.plala.or.jp Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toshiyuki Kubo, MD, Department of Gastroenterology and Hepatology, Sapporo Medical University, S1W16 Chuo-ku, Sapporo 0608543, Japan. kubo-t@grape.plala.or.jp
Telephone: +81-11-6112111 Fax: +81-11-6112282
Received: August 29, 2016
Peer-review started: August 31, 2016
First decision: September 21, 2016
Revised: October 7, 2016
Accepted: November 15, 2016
Article in press: November 16, 2016
Published online: December 7, 2016
Abstract
AIM

To identify risk factors for post-polypectomy bleeding (PPB), focusing on antithrombotic agents.

METHODS

This was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed.

RESULTS

PPB occurred in 29 (3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210 (26.6%) patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB (P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB (P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant.

CONCLUSION

Patients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.

Keywords: Post-polypectomy bleeding, Heparin bridge therapy, Colonic polypectomy, Anticoagulants, Antiplatelets, Endoscopic surgery

Core tip: Post-polypectomy bleeding (PPB) is the most common complication of colon polypectomy. In this study, we demonstrated that patients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients who take anticoagulants.