Why the study?
Does the management strategy of warfarin or DOACs affect the risk of post-polypectomy bleeding and thromboembolism in patients undergoing polypectomy?
Does the management strategy of warfarin or DOACs affect the risk of post-polypectomy bleeding and thromboembolism in patients undergoing polypectomy?
The study suggests that continuing anticoagulation may be safer than heparin bridging for patients undergoing polypectomy, challenging current endoscopy guidelines.
May warrant caution with polypectomy in anticoagulant users per guidelines; leaves open need for prospective trials to confirm PPB risks.
AIM: To verify the validity of the endoscopy guidelines for patients taking warfarin or direct oral anticoagulants (DOAC). METHODS: We collected data from 218 patients receiving oral anticoagulants (73 DOAC users, 145 warfarin users) and 218 patients not receiving any antithrombotics (age- and sex-matched controls) who underwent polypectomy. (1) We evaluated post-polypectomy bleeding (PPB) risk in patients receiving warfarin or DOAC compared with controls; (2) we assessed the risks of PPB and thromboembolism between three AC management methods: Discontinuing AC with heparin bridge (HPB) (endoscopy guideline recommendation), continuing AC, and discontinuing AC without HPB. RESULTS: = 0.087). These findings were significantly evident in warfarin but not DOAC users. One thrombotic event occurred in the discontinuing anticoagulant with HPB group and the discontinuing anticoagulant without HPB group; none occurred in the continuing anticoagulant group. CONCLUSION: PPB risk was similar between patients taking warfarin and DOAC. Thromboembolism was observed in warfarin users only. The guideline recommendations for HPB should be re-considered.
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Yanagisawa et al. (2018) studied this question.
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