November 07, 2018
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Continuing clopidogrel does not increase risk for bleeding after polypectomy

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Patients who continued using clopidogrel for the leadup and during colonoscopy did not have higher risk for bleeding after undergoing polypectomy, according to research published in Gastroenterology.

Francis K.L. Chan, MD, of the department of medicine and therapeutics at Prince of Wales Hospital and the Chinese University of Hong Kong, and colleagues wrote that their findings go against current guidelines about the use of the anti-platelet drug before polypectomy.

“Despite limited evidence, current U.S. and European Guidelines recommend withholding clopidogrel for at least seven days before colonoscopic polypectomy,” they wrote. “However, coronary stent thrombosis has been reported as early as seven days after stopping clopidogrel. There remains a large gap in our knowledge about the risk of bleeding in patients receiving clopidogrel who undergo invasive endoscopic procedures.”

Researchers recruited 387 patients receiving clopidogrel for cardiovascular disease who had to undergo colonoscopies in Hong Kong between 2012 and 2018. They instructed the patients to stop taking clopidogrel seven days before their procedure and randomly assigned them to receive either 75 mg of the drug or placebo once daily until the morning of the colonoscopy.

The primary endpoint of the study was delayed bleeding after polypectomy that required hospitalization or intervention up to 30 days after the procedure.

Overall, 216 patients required polypectomies (clopidogrel group, n = 106; placebo group, n = 110). Researchers found that patients in the clopidogrel group had a cumulative incidence rate of delayed bleeding of 3.8% (95% CI, 1.4%–9.7%), while the placebo group had a rate of 3.6% (95% CI, 1.4%–9.4%).

In the study’s two secondary endpoints, researchers found no significant difference in immediate bleeding or serious cardio-thrombotic events.

“Our study does not support the existing guidelines which recommend withholding clopidogrel seven days before polypectomy to reduce bleeding risk as among clopidogrel users undergoing colonoscopy,” Chan and colleagues wrote. “The rate of delayed and immediate bleeding was not statistically higher in patients who continued clopidogrel.”

They added that future research should focus on endoscopic prophylactic measures in patients taking clopidogrel and if clinicians should be using less cautery during polypectomies. – by Alex Young

Disclosures: Chan reports financial ties to AstraZeneca, Eisai, Otsuka, Pfizer and Takeda.