12/29/11

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FROM THE ANNUAL DIGESTIVE DISEASE WEEK

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Vitals

Major Finding: The incidence of postpolypectomy bleeding was not significantly different between patients who remained on antiplatelet therapy and control patients not using antiplatelets (0.8% vs. 0.3%).

Data Source: A case-control study of 1,967 adults.

Disclosures: Dr. Feagins said that she had received grants and/or research support from Centocor.

CHICAGO – The rate of postpolypectomy bleeding was less than 1% in clopidogrel patients who continued their medication through the procedure – not significantly higher than that of control patients not taking the antiplatelet drug, investigators reported at the annual Digestive Disease Week.

Current guidelines recommending that patients discontinue antiplatelet medications before an elective colonoscopy are based primarily on expert opinion rather than research studies, said Dr. Linda Feagins of the University of Texas Southwestern Medical Center in Dallas, and her colleagues.

"For our patients, we do not routinely discontinue clopidogrel before colonoscopy because we have judged the cardiovascular risks of that practice to exceed the risks of postpolypectomy bleeding," Dr. Feagins said.

In this study, Dr. Feagins and her colleagues reviewed data from 118 patients who were taking clopidogrel at the time of a polypectomy and 1,849 controls who were not taking clopidogrel. Propensity scoring was used to match clopidogrel patients with controls based on age, ethnicity, gender, use of nonsteroidal anti-inflammatory drugs, aspirin use, and factors including coronary artery disease, diabetes, hypertension, number of polyps removed, size of the largest polyp, and polypectomy techniques.

Overall, the frequency of postpolypectomy bleeding was not significantly different between the clopidogrel users and the controls (0.8% vs. 0.3%, respectively). Postpolypectomy bleeding was defined as rectal bleeding within 30 days of polypectomy and repeat colonoscopy confirming bleeding from a polypectomy site.

In addition, a matched analysis of 111 clopidogrel patients and 111 controls showed no significant difference between the two groups in the bleeding rate (0.9% vs. 0%, respectively).

Coronary artery disease was significantly more common among the clopidogrel users, compared with the controls (94% vs. 24%), as were aspirin use (78% vs. 28%) and lung disease (25% vs. 13%). In addition, the mean age of the clopidogrel users were significantly older than that of the controls (65 years vs. 62 years).

The study was limited by its retrospective nature, Dr. Feagins noted. In addition, 85% of the polyps removed in this study were less than 1 cm, suggesting that the results might not apply to polyps 1 cm or larger in size, she said. But the findings also suggest that many clopidogrel patients can safely continue their medications while undergoing polypectomies.

"We speculate that the cardiovascular risks of routinely discontinuing clopidogrel before elective colonoscopy may well exceed any excess risk of postpolypectomy bleeding," said Dr. Feagins. But more research is needed, and prospective studies are underway to further assess the risk of bleeding when patients do not discontinue their clopidogrel before a colonoscopy, she said.

Dr. Feagins said that she had received grants and/or research support from Centocor.

 

Heidi Splete is a senior writer with Elsevier Global Medical News.

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