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Risk of post-polypectomy bleeding after endoscopic mucosal resection in patients receiving antiplatelet medication: comparison between the continue and hold groups

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Abstract

Background

Current guidelines recommend continuing aspirin and discontinuing clopidogrel for colon polypectomy, but evidence for endoscopic mucosal resection (EMR) is insufficient. We aimed to assess post-polypectomy bleeding (PPB) in patients receiving antiplatelet agents and underwent EMR for various polyp sizes.

Methods

A single-center, prospective observational study was performed. Patients who underwent at least one EMR for polypectomy and those who received aspirin or clopidogrel were included. We compared PPB between the antiplatelet hold group (stopped antiplatelet therapy at least 5 days before the procedure) and continue group (antiplatelet therapy was maintained or stopped within 5 days before the procedure).

Results

Among patients who underwent EMR, 305 took aspirin (hold group 257, continue group 48) and 77 took clopidogrel (hold group 66, continue group 11). The mean number of polyps was four, and the mean size was 8.6 mm. There was no difference in the major PPB rate between the hold and continue groups among aspirin users (2.0% vs. 4.2%, P = 0.30), but it was significantly higher in the continue group than in the hold group among clopidogrel users (18.2% vs. 0%, P = 0.02). In patient- and polyp-based logistic regression analysis of clopidogrel users, the number of EMRs (OR 2.12, 95% CI 1.16–3.88), polyp size (OR 1.26, 95% CI 1.06–1.49), and continuing clopidogrel (OR 9.75, 95% CI 1.99–47.64) were independent risk factors for PPB.

Conclusion

Continuous administration of antiplatelet agents was significantly associated with higher PPB in clopidogrel users, but not in aspirin users. Endoscopists should consider holding clopidogrel if the EMR includes polypectomy.

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Funding

This study was supported by a National Research Foundation (NRF) Grant funded by the Korea government (NRF-2017R1A2B4006158).

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Author notes

  1. Soo-Kyung Park and Sang Hyun Park are co-first authors.

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, South Korea

    Soo-Kyung Park, Hyo-Joon Yang, Yoon Suk Jung, Jung Ho Park, Chong Il Sohn & Dong Il Park

  2. Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Sang Hyun Park

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  1. Sang Hyun Park
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Correspondence to Dong Il Park.

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Sang Hyun Park, Soo-Kyung Park, Hyo-Joon Yang, Yoon Suk Jung, Jung Ho Park, Chong Il Sohn, and Dong Il Park have no conflicts of interest.

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Park, S.H., Park, SK., Yang, HJ. et al. Risk of post-polypectomy bleeding after endoscopic mucosal resection in patients receiving antiplatelet medication: comparison between the continue and hold groups. Surg Endosc 36, 6410–6418 (2022). https://doi.org/10.1007/s00464-021-08987-w

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