Effect of antiplatelet agent number, types, and pre-endoscopic management on post-polypectomy bleeding: validation of endoscopy guidelines

Abstract

Background

It remains unclear whether type of antiplatelet (AP) therapy, AP combination therapy, and AP continuing or switching strategy affect the risk of post-polypectomy bleeding (PPB). In this study, we sought to elucidate this risk.

Methods

We analyzed 1050 patients who underwent colonoscopic polypectomy: 525 AP users and 525 controls matched for age, sex, comorbidities, concomitant non-steroidal anti-inflammatory drugs use, and polyp characteristics who did not receive antithrombotics. PPB risk was evaluated by AP number, type, and continuing or switching strategies during the peri-endoscopic period.

Results

In multivariate analysis, bleeding risk increased significantly as the number of AP agents used increased (monotherapy, adjusted odds ratio [aOR], 3.7; dual antiplatelet therapy (DAPT), 4.6; triple antiplatelet therapy (TAPT), 11.1) compared with controls. With monotherapy, significantly increased PPB risk was found for aspirin (aOR 4.3), thienopyridine (aOR 6.3), and cilostazol (aOR 5.9), but not for eicosapentaenoic acid or other APs (beraprost, limaprost, sarpogrelate, dilazep, or dipyridamole). With DAPT, significantly increased PPB risk was found for combination aspirin plus cilostazol, but not aspirin plus other APs. Bleeding rates for continuing monotherapy were 4.3% for aspirin and 0% for thienopyridine, cilostazol, and other APs, respectively.

Conclusions

Analysis of this large polypectomy dataset showed that the use of low-dose aspirin, thienopyridine, or cilostazol and a combination of these is associated with increased PPB risk. Although PPB risk was high with DAPT or TAPT, PPB rate in any antiplatelet monotherapy even with a continuing strategy was low at < 5%.

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Acknowledgements

The authors thank clinical research coordinators Kuniko Miki, Kenko Yoshida, Eiko Izawa, and Hisae Kawashiro for their assistance with data collection.

Funding

This work was supported in part by a Grant-in-Aid for Research from the National Center for Global Health and Medicine (29-2001), and International Medical Research and Development Expenses from the National Center for Global Health and Medicine (30-1020). The funding agency played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Correspondence to Naoyoshi Nagata.

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Drs. Kazuhiro Watanabe, Naoyoshi Nagata, Naohiro Yanagisawa, Takuro Shimbo, Hidetaka Okubo, Koh Imbe, Chizu Yokoi, Mikio Yanase, Akio Kimura, Junichi Akiyama and Naomi Uemura, MD have no conflicts of interest or financial ties to disclose.

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Watanabe, K., Nagata, N., Yanagisawa, N. et al. Effect of antiplatelet agent number, types, and pre-endoscopic management on post-polypectomy bleeding: validation of endoscopy guidelines. Surg Endosc 35, 317–325 (2021). https://doi.org/10.1007/s00464-020-07402-0

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Keywords

  • Dual antiplatelet therapy (DAPT)
  • acetylsalicylic acid
  • Delayed bleeding
  • ASGE guidelines
  • ESGE guidelines
  • JGES guidelines