Risk of Post Colonoscopic Polypectomy Bleeding in Patients on New Oral Anti-Coagulant and a Case Control Study
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摘要Background

Anticoagulants are commonly used to treat patients with cardiovascular and cerebrovascular diseases. Recently developed new oral anticoagulants (NOAC) that are direct thrombin inhibitor and direct factor Xa inhibitor overcome some limitations of vitamin K antagonist, including drug drug interaction and regular dose adjustments on the basis of laboratory monitoring. The risk of post polypectomy bleeding (PPB) in patients on anti-platelet therapy and vitamin K antagonist had been well studied. However, data on the risk of post polypectomy bleeding in patients on NOAC was absent.

Patients and Methods

Data of consecutive inpatients with age between 18 – 89 in five year period (from 2012 to 2016), who underwent colonoscopic polypectomy with NOAC therapy (dabigatran, rivaroxaban and apixaban), were collected in all Hong Kong Public Hospitals by Clinical Data Analysis and Reporting System (CDARS). Patients underwent colonoscopic polypectomy without anti-platelet, anti-coagulation and NOAC were collected from the same system, matched with age and sex match during the same study period with a ratio 1:3, were recrutied as control. Post polypectomy bleeding was defined as fresh PR bleed after procedure with at least 2g/dL drop in haemoglobin, requiring blood transfusion, repeat endoscopy for haemostasis or surgical intervention within 30 days of index colonoscopy. The characteristic and relative risk of PPB were analysed.

Results

Among 272 patients on NOAC underwent colonoscopy, 104 patients underwent colonoscopic polypectomy. 8 / 104 (7.7%) patients had PPB. In the control group, 2 / 312 (0.6%) patients had PPB. The relative risk of PPB in patients on NOAC was 13.6 (p=0.0002). (Table 1) The onset of PPB in patients with NOAC range from day 1 to day 25 (median day 8). 5 patients underwent repeat colonoscopy and 3 patients were treated with supportive transfusion. No patients need surgery for haemostasis. (Table 2)

Conclusions

The risk of post colonoscopic polypectomy bleeding in patients with NOAC is high and often delay in presentation.
著者Long Yan K. Lam, Siew C. Ng, Jessica Ching, Sunny H. Wong, Thomas Y. Lam, Francis K. Chan
會議名稱Digestive Disease Week 2017
會議開始日06.05.2017
會議完結日09.05.2017
會議地點Chicago, Illinois
會議國家/地區美國
期刊名稱Gastrointestinal Endoscopy
會議論文集題名DDW 2017 ASGE Program and Abstracts
出版年份2017
月份5
卷號85
期次5 Supplement
出版社Elsevier
頁次AB374 - AB374
國際標準期刊號0016-5107
電子國際標準期刊號1097-6779
語言英式英語

上次更新時間 2020-18-10 於 02:27