Key result
Direct oral anticoagulants did not increase the risk of delayed postpolypectomy bleeding compared to clopidogrel (OR 0.929).
Why the study?
With the usage of DOACs to prevent and treat thromboembolic events gradually increasing, the outcomes of patients taking DOACs after polypectomy required evaluation.
Does the use of direct oral anticoagulants increase the risk of delayed postpolypectomy bleeding compared to clopidogrel in patients undergoing colonoscopic polypectomy?
Cohort (n=401)
No
Does the use of direct oral anticoagulants increase the risk of delayed postpolypectomy bleeding compared to clopidogrel in patients undergoing colonoscopic polypectomy?
Odds Ratio: 0.929 (95% CI 0.436–1.975)
Absolute Event Rate: 1.6% vs 1.6%
p-value: p=0.847
In patients undergoing colonoscopic polypectomy, the use of direct oral anticoagulants does not increase the risk of delayed bleeding compared to clopidogrel when standard discontinuation guidelines are followed.
The usage of direct oral anticoagulants (DOACs) to prevent and treat thromboembolic events is gradually increasing. We aimed to evaluate the outcomes of patients taking DOACs after polypectomy. We retrospectively reviewed 131 patients taking DOACs and 270 taking clopidogrel who underwent polypectomy between November 2010 and December 2017. The risk of delayed postpolypectomy bleeding (PPB) was evaluated and compared. A total of 989 polyps were removed (320 polyps in the DOAC and 669 polyps in the clopidogrel group). DOACs and clopidogrel were discontinued for 2.8 ± 1.7 days and 5.8 ± 2.5 days before polypectomy, respectively. DOACs and clopidogrel were restarted on 1.6 ± 2.9 days and 1.7 ± 1.1 days after polypectomy, respectively. According to per polyp analysis, delayed PPB rate was 1.6% in both groups (p = 0.924). Logistic regression analysis was performed after propensity score matching and revealed that DOACs did not increase the delayed PPB risk compared to clopidogrel (OR 0.929, 95% CI 0.436-1.975, p = 0.847). With the majority following the antithrombotic discontinuation guidelines, the incidence of delayed PPB was 3.1% in the patients taking DOACs. The delayed PPB risk was not greater in those taking DOACs than in those taking clopidogrel.
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Kim et al. (2021) conducted a cohort in Colon polyps requiring polypectomy in patients on antithrombotics (n=401). Direct oral anticoagulants (DOACs) vs. Clopidogrel was evaluated on Delayed postpolypectomy bleeding (PPB) (OR 0.929, 95% CI 0.436-1.975, p=0.847). Direct oral anticoagulants did not increase the risk of delayed postpolypectomy bleeding compared to clopidogrel (OR 0.929).
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