Key result
Continuing clopidogrel during polypectomy yields no post-procedural bleeding but raises clip-requiring intraprocedural bleeds to ~22%.
Why the study?
Optimal peri-colonoscopic management of clopidogrel remains unclear.
Does continuation of clopidogrel increase clinically significant postpolypectomy bleeding in patients undergoing cold snare polypectomy for colorectal polyps ≤ 10 mm compared to temporary replacement with aspirin?
RCT (n=107)
Single-blind
randomized
Yes
Does continuation of clopidogrel increase clinically significant postpolypectomy bleeding in patients undergoing cold snare polypectomy for colorectal polyps ≤ 10 mm compared to temporary replacement with aspirin?
Absolute Event Rate: 22.4% vs 4.7%
p-value: p=0.02
Continuation of clopidogrel during cold snare polypectomy for polyps ≤ 10 mm does not increase clinically significant postpolypectomy bleeding, though it increases intraprocedural bleeding that can be managed with clips.
Supports continuing clopidogrel for cold snare polypectomy of polyps ≤10 mm; extends RCT evidence on periprocedural antiplatelet safety.
Background and study aims Optimal peri-colonoscopic management of clopidogrel remains unclear. Cold snare polypectomy is safe and effective for removing polyps ≤ 10 mm and clips can control intraprocedural bleeding. We conducted a randomized controlled trial to compare continuation of clopidogrel versus temporary replacement of clopidogrel with aspirin for routine colonoscopy using cold snare polypectomy for polyps ≤ 10 mm. Patients and methods Between August 2016 and August 2019, consenting participants at 12 centers were randomized to continuation of clopidogrel as a single or dual antiplatelet agent, or to temporarily take aspirin alone from 7 days prior to 2 days after routine colonoscopy. Endoscopists were blinded to group allocation. Cold snare polypectomy was used to remove polyps ≤ 10 mm, with endoscopic clips applied if intraprocedural bleeding continued for > 2 minutes. Follow-up was performed on Day 30. The trial was stopped early due to delayed patient enrollment. Results Two hundred seventy-six consecutive polyps ≤ 10 mm were removed from 107 patients. Of the patients, 61.7 % were male with a median age of 69 years (interquartile range [IQR] 63 to 76.75). Fifty-nine patients continued on clopidogrel and 48 temporarily took aspirin instead. One hundred thirty-four polyps were removed from 49 patients who continued on clopidogrel vs 142 from 43 patients temporarily took aspirin instead (P = 0.33). Intraprocedural bleeding requiring clips occurred in 11 of 49 patients who continued on clopidogrel and in two of 43 patients who temporarily took replacing with aspirin instead (P = 0.02). More post-procedural minor bleeding was seen in the aspirin arm (six of 43 vs one of 49; P = 0.03). One patient in each arm had acute coronary syndrome, which was medically managed. None of the patients had clinically significant post-procedural bleeding. Conclusions Continuation of clopidogrel in patients undergoing cold snare polypectomy for colorectal polyps ≤ 10 mm does not appear to increase the rate of clinically significant postpolypectomy bleeding. It is associated with an increase in intraprocedural bleeding, which can be successfully treated with clips.
No takes yet. Share an insight, caveat, or question.
Ket et al. (2022) conducted an RCT in Colorectal polyps ≤ 10 mm (n=107). Continuation of clopidogrel vs. Temporary replacement of clopidogrel with aspirin was evaluated on Intraprocedural bleeding requiring clips (p=0.02). Continuation of clopidogrel during cold snare polypectomy for polyps ≤10 mm did not cause clinically significant post-procedural bleeding, though intraprocedural bleeding requiring clips increased (22.4% vs 4.7%; P=0.02).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: