Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin.
BACKGROUND
Limited data exist on the role of aspirin in increasing the risk of clinically significant postpolypectomy bleeding (PPB), which is defined as lower gastrointestinal (GI) hemorrhage following colonoscopic polyp removal requiring transfusion, hospitalization, endoscopic intervention, angiography, or surgery.


OBJECTIVE
To determine if aspirin use prior to colonoscopy increases the risk of clinically significant PPB.


METHODS
A case-control study of patients with clinically significant PPB at Mayo Clinic Scottsdale and Rochester was performed. Information collected included age, gender, recent use of aspirin or NSAIDs (within three days of colonoscopy), polyp characteristics, and polypectomy technique. The control group consisted of patients matched for age (+/-3 yr), gender, and cardiovascular morbidity who had undergone polypectomy without any complications. The populations were compared to determine the odds ratio (OR) of PPB with aspirin use.


RESULTS
During the study period, 20,636 patients underwent colonoscopy with polypectomy at the two institutions and 101 patients presented with clinically significant PPB. Twenty patients were excluded from analysis because of prior anticoagulant use. The remaining 81 patients were matched to 81 patients who had undergone colonoscopy without complications. The two groups were comparable in terms of polyp size (97%< or = 10 mm, bleeding group; 95%< or = 10 mm, control group). Aspirin use prior to polypectomy was 40% in the bleeding group and 33% in the control group (OR 1.41; 95% C.I. 0.68 to 3.04).


CONCLUSIONS
Postpolypectomy bleeding is an uncommon but important complication of endoscopic polypectomy. There was no statistically relevant difference in prior aspirin use before polypectomy in the bleeding group and the matched controls.
Yousfi
Mahmoud
M
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA.
Gostout
Christopher J
CJ
Baron
Todd H
TH
Hernandez
Jose L
JL
Keate
Ray
R
Fleischer
David E
DE
Sorbi
Darius
D
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001803:Blood Transfusion; D016022:Case-Control Studies; D003111:Colonic Polyps / Q000175:diagnosis / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate
D001241:Aspirin