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News

Colonoscopic post-polypectomy bleeding with continued clopidogrel therapy

The latest Alimentary Pharmacology & Therapeutics investigates colonoscopic post-polypectomy bleeding in patients on continued clopidogrel therapy.

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Current guidelines recommend the cessation of clopidogrel therapy 5 days and 7–10 days prior to colonoscopic polypectomy.

Recent studies have advocated for continued clopidogrel as post-polypectomy bleeding rates have been similar to those in the general population not on antithrombotic therapy.

Dr Gandhi and colleagues assessed colonoscopic post-polypectomy bleeding in patients on continued clopidogrel therapy.

A literature search was conducted for studies that investigated post-polypectomy bleeding in patients on continued clopidogrel therapy.

The doctors' primary outcome of interest was the pooled relative risk ratio of colonoscopic post-polypectomy bleeding in patients on continued clopidogrel therapy vs. controls.

Secondary outcomes were a comparison of immediate and delayed colonoscopy post-polypectomy bleeding in patients on continued clopidogrel therapy vs. controls.

The research team reported that 5 observational studies included 574 subjects on continued clopidogrel therapy, and 6169 control subjects.

Immediate post-polypectomy bleeding there was a nonsignificant pooled risk ratio of 1.8
Alimentary Pharmacology & Therapeutics

The pooled risk ratio for post-polypectomy bleeding on continued clopidogrel therapy was 2.5.

The team of doctors examined that for immediate post-polypectomy bleeding there was a nonsignificant pooled risk ratio of 1.8, and delayed post-polypectomy bleeding there was a significant pooled risk ratio of 4.7.

Dr Gandhi's team concluded "The results of this meta-analysis suggest that continued clopidogrel increases the risk of delayed but not immediate post-polypectomy bleeding."

"Clopidogrel interruption in individuals with coronary artery disease predisposes to serious acute ischemic events."

"In high-risk patients, endoscopists should be cognisant of these risks and consider deferring elective colonoscopy and polypectomy until it is considered safe to interrupt clopidogrel therapy."

Aliment Pharmacol Ther 2013: 37(10): 947-952
29 April 2013

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