title: Low rate of postpolypectomy bleeding among patients who continue thienopyridine therapy during colonoscopy.
abstract: OBJECTIVE
  It is not clear whether the cardiovascular risk of discontinuing treatment with antiplatelet agents, specifically the thienopyridines, before elective colonoscopy outweighs the risks of postpolypectomy bleeding (PPB). We studied the rate of PPB in patients who continue thienopyridine therapy during colonoscopy.
  
  
  METHODS
  We performed a prospective study of 516 patients not taking warfarin who received polypectomies during elective colonoscopies; 219 were receiving thienopyridines, and 297 were not (controls). The occurrence of immediate PPB and delayed PPB was recorded. Delayed PPB was categorized as clinically important if it resulted in repeat colonoscopy, hospitalization, or blood transfusion.
  
  
  RESULTS
  Patients receiving thienopyridines were older and had significantly more comorbid diseases than controls; the mean number of polyps removed per patient was significantly higher (3.9 vs 2.9) in the thienopyridine group. Immediate PPB developed in 16 patients in the thienopyridine group (7.3%) and in 14 in the control group (4.7%, P = .25). Among patients who completed a 30-day follow-up analysis (96% of patients enrolled), clinically important, delayed bleeding occurred in 2.4% of patients receiving thienopyridines and in none of the controls (P = .01). All PPB events in both groups were resolved without surgery, angiography, or death.
  
  
  CONCLUSIONS
  Although a significantly higher percentage of patients who continue thienopyridine therapy during colonoscopy and polypectomy develop clinically important delayed PPB than patients who discontinue therapy, the rate of PPB events is low (2.4%), and all are resolved without sequelae. The risk for catastrophic cardiovascular risks among patients who discontinue thienopyridine therapy before elective colonoscopies could therefore exceed the risks of PPB. ClinicalTrials.gov, Number NCT01647568.
authors: Division of Gastroenterology, North Texas VA Health Care System, Dallas, Texas; Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Linda.Feagins@UTSouthwestern.edu.
authors: Linda A
authors: LA
authors: Feagins
authors: Ramiz
authors: R
authors: Iqbal
authors: William V
authors: WV
authors: Harford
authors: Akeel
authors: A
authors: Halai
authors: Byron L
authors: BL
authors: Cryer
authors: Kerry B
authors: KB
authors: Dunbar
authors: Raquel E
authors: RE
authors: Davila
authors: Stuart J
authors: SJ
authors: Spechler
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000009:adverse effects*; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D007417:Intestinal Polyps / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*
chemical_list: D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine
keywords: CI; Clopidogrel; Complication; Heart Disease; Hemorrhage; NSAID; PPB; VA; Veterans Affairs; confidence interval; nonsteroidal anti-inflammatory drug; postpolypectomy bleeding