AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that o...AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed. RESULTS PPB occurred in 29(3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210(26.6%)patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB(P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB(P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant. CONCLUSION Patients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.展开更多
Glanzmann's thrombasthenia(GT) is a rare autosomal recessive bleeding syndrome characterized by abnormal Glycoprotein Ⅱb/Ⅲa complex(GⅡb/Ⅲa) on platelets with resultant abnormality in platelet aggregation.There...Glanzmann's thrombasthenia(GT) is a rare autosomal recessive bleeding syndrome characterized by abnormal Glycoprotein Ⅱb/Ⅲa complex(GⅡb/Ⅲa) on platelets with resultant abnormality in platelet aggregation.There is very little information regarding polypectomy management in GT.We report a single patient with this rare disease,who underwent sequential endoscopic management of large colon polyps.Polypectomy in our GT patient was complicated by immediate and delayed bleeding.Multiple clips used after standard cautery polypectomy for a polyp 10 mm or larger in our GT patient,was most effective in preventing immediate and delayed post-polypectomy bleeding than other known therapeutic approaches.We favor preemptive use of multiple clips in large polypectomy defects for GT patients and we may argue the added cost may be offset by the reduction in the need for blood products,and by averting or shortening potential hospitalizations.展开更多
文摘AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed. RESULTS PPB occurred in 29(3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210(26.6%)patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB(P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB(P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant. CONCLUSION Patients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.
文摘Glanzmann's thrombasthenia(GT) is a rare autosomal recessive bleeding syndrome characterized by abnormal Glycoprotein Ⅱb/Ⅲa complex(GⅡb/Ⅲa) on platelets with resultant abnormality in platelet aggregation.There is very little information regarding polypectomy management in GT.We report a single patient with this rare disease,who underwent sequential endoscopic management of large colon polyps.Polypectomy in our GT patient was complicated by immediate and delayed bleeding.Multiple clips used after standard cautery polypectomy for a polyp 10 mm or larger in our GT patient,was most effective in preventing immediate and delayed post-polypectomy bleeding than other known therapeutic approaches.We favor preemptive use of multiple clips in large polypectomy defects for GT patients and we may argue the added cost may be offset by the reduction in the need for blood products,and by averting or shortening potential hospitalizations.
