title: Heparin-bridging therapy and risk of post-polypectomy bleeding: Meta-analysis of data reported by Japanese colonoscopists.
abstract: OBJECTIVE
  Peri-procedural bridging (PPB) with heparin is recommended for patients with high thromboembolic risk who need to withhold antithrombotic therapy for colonoscopic polypectomy. However, little is known about the bleeding risk from heparin-bridging therapy itself.
  
  
  METHODS
  MEDLINE and EMBASE databases were searched through January 2017 for studies that compared the risk of PPB in patients who received heparin-bridging therapy in lieu of antithrombotic agents for colonoscopic polypectomy and those who discontinued antithrombotic agents without receiving heparin. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model, generic inverse variance method. Between-study heterogeneity was quantified using the Q statistic and I2.
  
  
  RESULTS
  A total of five studies consisting of 2601 patients were identified. A significantly increased risk of PPB among bridged patients compared to non-bridged patients was demonstrated with a pooled OR of 8.29 (95% CI, 4.96-13.87). Statistical heterogeneity was low with I2of 0%.
  
  
  CONCLUSIONS
  The present study demonstrated a significantly increased risk of PPB among patients who underwent colonoscopic polypectomy and received heparin-bridging therapy in lieu of antithrombotic agents compared to patients who did not receive it.
authors.affiliation: Department of Internal Medicine, University of Hawaii, Honolulu, USA.|Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Veeravich
authors.identifier: http://orcid.org/0000-0002-3419-2296
authors.initials: V
authors.lastname: Jaruvongvanich
authors.affiliation: Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
authors.forename: Buravej
authors.initials: B
authors.lastname: Assavapongpaiboon
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, USA.
authors.forename: Karn
authors.initials: K
authors.lastname: Wijarnpreecha
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, USA.|Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Patompong
authors.initials: P
authors.lastname: Ungprasert
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D015331:Cohort Studies; D003111:Colonic Polyps / Q000175:diagnosis / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods; D016001:Confidence Intervals; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: anticoagulant; colonoscopic polypectomy; heparin; post-polypectomy bleeding; warfarin