title: Heparin bridge therapy and post-polypectomy bleeding.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Toshiyuki Kubo, Kentaro Yamashita, Kei Onodera, Tomoya Iida, Hiroshi Nakase, Department of Gastroenterology and Hepatology, Sapporo Medical University, Sapporo 0608543, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kubo
authors.affiliation: Toshiyuki Kubo, Kentaro Yamashita, Kei Onodera, Tomoya Iida, Hiroshi Nakase, Department of Gastroenterology and Hepatology, Sapporo Medical University, Sapporo 0608543, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Toshiyuki Kubo, Kentaro Yamashita, Kei Onodera, Tomoya Iida, Hiroshi Nakase, Department of Gastroenterology and Hepatology, Sapporo Medical University, Sapporo 0608543, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Onodera
authors.affiliation: Toshiyuki Kubo, Kentaro Yamashita, Kei Onodera, Tomoya Iida, Hiroshi Nakase, Department of Gastroenterology and Hepatology, Sapporo Medical University, Sapporo 0608543, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Iida
authors.affiliation: Toshiyuki Kubo, Kentaro Yamashita, Kei Onodera, Tomoya Iida, Hiroshi Nakase, Department of Gastroenterology and Hepatology, Sapporo Medical University, Sapporo 0608543, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Arimura
authors.affiliation: Toshiyuki Kubo, Kentaro Yamashita, Kei Onodera, Tomoya Iida, Hiroshi Nakase, Department of Gastroenterology and Hepatology, Sapporo Medical University, Sapporo 0608543, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Nojima
authors.affiliation: Toshiyuki Kubo, Kentaro Yamashita, Kei Onodera, Tomoya Iida, Hiroshi Nakase, Department of Gastroenterology and Hepatology, Sapporo Medical University, Sapporo 0608543, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D000077407:Cilostazol; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy; D000069340:Deprescriptions; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D006493:Heparin; D000077407:Cilostazol; D001241:Aspirin
keywords: Anticoagulants; Antiplatelets; Colonic polypectomy; Endoscopic surgery; Heparin bridge therapy; Post-polypectomy bleeding