Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy

Background

The risk of postpolypectomy bleeding (PPB) in patients undergoing colonoscopy on uninterrupted clopidogrel therapy has not been established.

Objective

To assess the PPB rate and outcome and identify risk factors associated with PPB in patients taking clopidogrel.

Design

Single-center, retrospective study. Demographics, clinical parameters, polyp characteristics, polypectomy techniques, and postpolypectomy events in the groups were compared by univariate analysis. Stepwise logistic regression analyses identified independent risk factors associated with PPB.

Setting

Veterans Affairs Medical Center.

Patients

A total of 142 patients (375 polypectomies) taking clopidogrel (cases) and 1243 patients (3226 polypectomies) not taking clopidogrel (controls).

Interventions

None.

Main Outcome Measurements

Postpolypectomy bleeding, hospitalization, and mortality.

Results

The immediate (intraprocedural) bleeding rate was similar in the 2 groups (2.1% vs 2.1%). Delayed (postprocedural) PPB rate was higher in the group taking clopidogrel (3.5% vs 1.0%, P = .02). Delayed bleeding of significance requiring hospitalization and transfusion/intervention was also higher in patients taking clopidogrel (2.1% vs 0.4%, P = .04). The length of hospital stay and interventions for PPB were comparable between the 2 groups. There was no mortality. Concomitant use of clopidogrel and aspirin/other nonsteroidal anti-inflammatory drugs (odds ratio 3.7; 95% CI, 1.6-8.5) and the number of polyps removed (OR 1.3; 95% CI, 1.2-1.4) were the only significant risk factors associated with PPB. Clopidogrel alone was not an independent risk factor for PPB.

Limitations

Retrospective study and small number of patients with PPB.

Conclusions

The PPB rate is significantly higher in patients undergoing polypectomy while taking clopidogrel and concomitant aspirin/nonsteroidal anti-inflammatory drugs; however, the risk is small and the outcome is favorable. Routine cessation of clopidogrel in patients before colonoscopy/polypectomy is not necessary.

Abbreviations: ASA, aspirin, CAD, coronary artery disease, COPD, chronic obstructive pulmonary disease, CrCl, creatinine clearance, DM, diabetes mellitus, HTN, hypertension, NSAID, nonsteroidal anti-inflammatory drug, OR, odds ratio, PPB, postpolypectomy bleeding, PPI, proton pump inhibitor, VAMC, Veterans Affairs Medical Center