Risk of Postpolypectomy Bleeding With Uninterrupted Clopidogrel Therapy in an Industry- Independent, Double- Blind, Randomized Trial
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AbstractBackground & Aims
Guidelines recommend withholding clopidogrel 7 days before polypectomy to reduce bleeding risk, but these were written based on limited evidence. We investigated whether uninterrupted clopidogrel therapy increases the risk of delayed post-polypectomy bleeding in patients undergoing colonoscopy.

Methods
We identified patients receiving clopidogrel for cardiovascular disease undergoing elective colonoscopies in Hong Kong, from 28 February 2012 through 11 April 2018. Eligible patients were instructed to stop taking clopidogrel 7 days before colonoscopy. They were then randomly assigned to groups given clopidogrel (75 mg) or placebo, daily until the morning of colonoscopy. All patients resumed their usual prescriptions of clopidogrel after colonoscopy. The primary endpoint was delayed post-polypectomy bleeding that required hospitalization or intervention up to 30 days after colonoscopy. Secondary endpoints were immediate post-polypectomy bleeding and serious cardio-thrombotic events for as long as 6 months after colonoscopy, according to anti-thrombotic trialist’s criteria. All events were adjudicated by an independent, masked committee.

Results
A total of 387 patients underwent colonoscopy and 216 required polypectomies (106 patients in the clopidogrel group and 110 patients in the placebo group). The cumulative incidence of delayed post-polypectomy bleeding was 3.8% (95% CI, 1.4%–9.7%) in the clopidogrel group and 3.6% (95% CI, 1.4%–9.4%) in the placebo group (log-rank test P=.945). There were no significant differences in immediate post-polypectomy bleeding (8.5% vs 5.5%, P=.380) and cardio-thrombotic events (1.5% vs 2%, P=.713).

Conclusions
In a randomized controlled trial of clopidogrel users undergoing colonoscopy, a slightly higher proportion of patients continuing clopidogrel developed delayed and immediate post-polypectomy bleeding, although this difference was not statistically significant. ClinicalTrials.gov: NCT01806090
Acceptance Date22/10/2018
All Author(s) ListChan FKL, Kyaw MH, Hsiang JC, Suen BY, Kee KM, Tse YK, Ching JYL, Cheong PK, Ng D, Lam K, Lo A, Lee V, Ng SC
Journal nameGastroenterology
Year2019
Month3
Volume Number156
Issue Number4
PublisherElsevier
Pages918 - 925.e1
ISSN0016-5085
LanguagesEnglish-United Kingdom
KeywordsCUP Trial, anti-thrombotics, endoscopy, anti-platelets

Last updated on 2020-28-05 at 02:23