Colonoscopy with polypectomy in anticoagulated patients.
BACKGROUND
According to current practice guidelines for performance of colonoscopy in patients requiring long-term anticoagulation, polypectomy is considered a high-risk procedure for which anticoagulation must temporarily be discontinued. However, these guidelines are based on expert opinion, and the bleeding risk after polypectomy in anticoagulated patients is not known.


OBJECTIVE
Measure the risk of postpolypectomy bleeding in patients who undergo colonoscopic polypectomy while anticoagulated.


METHODS
Retrospective review of patients who underwent polypectomy without discontinuation of anticoagulation.


METHODS
Veterans Administration Palo Alto Health Care System.


METHODS
Forty-one polypectomies were performed in 21 patients. All patients had been receiving long-term anticoagulation with warfarin; the average international normalized ratio was 2.3 (range 1.4-4.9; normal 0.9-1.2). To prevent supratherapeutic anticoagulation, warfarin was withheld for 36 hours before the procedure while the patients were on a liquid diet. The average polyp size was 5 mm (range 3-10 mm).


METHODS
All patients underwent polypectomy followed immediately by prophylactic application of one or two clips to prevent bleeding.


METHODS
Rate of postpolypectomy bleeding.


RESULTS
There were no episodes of postpolypectomy bleeding. The 95% CI for the risk of bleeding was 0% to 8.6% when analyzed per polypectomy and 0% to 15% when analyzed per patient.


CONCLUSIONS
Small single-center retrospective study.


CONCLUSIONS
Our experience suggests that small polyps can be removed with a very low risk of bleeding when clips are applied immediately after polypectomy. If these results can be confirmed in a larger multicenter study, our protocol may become an alternative to withholding anticoagulation in patients at high risk of thrombosis.
Friedland
Shai
S
Stanford University, and Veterans Administration Palo Alto Health Care System, 3801 Miranda Avenue-G1 111, Palo Alto, CA 94305, USA.
Soetikno
Roy
R
D000925:Anticoagulants / Q000008:administration & dosage; D003111:Colonic Polyps / Q000453:epidemiology / Q000601:surgery*; D003113:Colonoscopy; D015897:Comorbidity; D016558:Hemostasis, Endoscopic; D006801:Humans; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D014859:Warfarin