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 from Canada 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 researchers' 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 team identified 5 observational studies that included 574 subjects on continued clopidogrel therapy, and 6169 control subjects.
The team of doctors examined that the pooled risk ratio for post-polypectomy bleeding on continued clopidogrel therapy was 2.5.
|The calculated pooled gastric cancer incidence-rate was about 0.3% per person-years|
|Alimentary Pharmacology & Therapeutics|
For immediate post-polypectomy bleeding there was a nonsignificant pooled relative risk of 1.8, and delayed post-polypectomy bleeding there was a significant pooled risk ratio of 4.7.
Dr Gandhi's team commented "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 ischaemic 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."