Patients who take direct-acting oral anticoagulants and undergo colonoscopy are at low risk for postpolypectomy complications, including gastrointestinal bleeding and myocardial infarction, according to research published in Clinical Gastroenterology and Hepatology.
Jessica X. Yu, MD, MS, of the division of gastroenterology and hepatology at Stanford University School of Medicine, and colleagues wrote that direct-acting oral anticoagulants (DOACs) have become much more common, and recommendations vary about their use before polypectomy.
“Over the past decade, these agents have been increasingly prescribed, and account for over half of all new anticoagulation prescriptions in patients with [atrial fibrillation],” they wrote. “Current guidelines recommend that DOACs and other antithrombotic medications be held prior to polypectomy, with or without bridge therapy. However, more recent literature suggests that DOACs may be safer than warfarin in terms for postendoscopic bleeding.”
Researchers performed a retrospective analysis to determine the risk for postpolypectomy complications in patients who received DOACs. Using the Clinformatics Data Mart Database, they identified 11,504 patients who took antithrombotic agents between 2011 and 2015 (DOAC, n = 1,590; warfarin, n = 3,471; clopidogrel, n = 6,443) and 599,983 controls. They compared 30-day complications following polypectomy, including GI bleeding, cerebrovascular accident (CVA), myocardial infarction and hospital admissions.
Investigators found that the percentage of patients in the DOAC group who had GI bleeding (0.63%; 95% CI, 0.3%–1.2%) and CVA (0.06%; 95% CI, 0.01%–0.35%) was higher compared with the control group.
However, after they adjusted for factors that were associated with increased odds for complications, including bridge anticoagulation, EMR, Charlson comorbidity index (CCI), and CHADS2 (congestive heart failure, hypertension, age over 75, diabetes, stroke [double weight]) score, patients who took DOACs had no significantly greater risk for GI bleeding (OR = 0.9; 95% CI, 0.44–1.85), CVA (OR = 0.45; 95% CI, 0.06–3.28), myocardial infarction (OR = 1.07; 95% CI, 0.14–7.72), or hospital admission (OR = 0.86; 95% CI, 0.64–1.16).
“The overall rates of complications in polypectomy or [endoscopic mucosal resection] patients were low, but higher in patients prescribed any antithrombotics compared to patients in the control group,” Yu and colleagues wrote. “After adjusting for bridge anticoagulation use, patient comorbidities, and procedure type, patients prescribed DOACs did not have a statistically significant increase in the odds of [GI bleeding}, CVA, [myocardial infarction], or admissions as compared to the control group.”
Researchers wrote that future studies are needed to explore optimal periprocedural dosing, patients with higher risk and bleeding prophylaxis. – by Alex Young
Disclosures: The authors report no relevant financial disclosures.