Risk of colonoscopic post-polypectomy bleeding in patients on single antiplatelet therapy: systematic review with meta-analysis

被引:9
作者
Valvano, Marco [1 ]
Fabiani, Stefano [1 ]
Magistroni, Marco [1 ]
Mancusi, Antonio [1 ]
Longo, Salvatore [1 ]
Stefanelli, Gianpiero [1 ]
Vernia, Filippo [1 ]
Viscido, Angelo [1 ]
Romano, Silvio [2 ]
Latella, Giovanni [1 ]
机构
[1] Univ Aquila, Dept Life Hlth & Environm Sci, Gastroenterol Unit, Piazzale Salvatore Tommasi 1, I-67100 Laquila, Italy
[2] Univ Aquila, Dept Life Hlth & Environm Sci, Cardiol Unit, Laquila, Italy
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2022年 / 36卷 / 04期
关键词
Aspirin; Platelet aggregation inhibitors; Antiplatelet agents; Haemorrhage; Intestinal polyps; Colonoscopy; Polypectomy; Post-polypectomy bleeding; ANTITHROMBOTIC AGENTS; EUROPEAN-SOCIETY; MANAGEMENT; ANTICOAGULANTS; COMPLICATIONS; GUIDELINES; ASPIRIN; QUALITY; TRENDS; GRADE;
D O I
10.1007/s00464-021-08975-0
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background It was not yet fully established whether the use of antiplatelet agents (APAs) is associated with an increased risk of colorectal post-polypectomy bleeding (PPB). Temporarily, discontinuation of APAs could reduce the risk of PPB, but at the same time, it could increase the risk of cardiovascular disease recurrence. This study aimed to assess the PPB risk in patients using APAs compared to patients without APAs or anticoagulant therapy who had undergone colonoscopy with polypectomy. Methods A systematic electronic search of the literature was performed using PubMed/MEDLINE, Scopus, and CENTRAL, to assess the risk of bleeding in patients who do not interrupt single antiplatelet therapy (P2Y12 inhibitors or aspirin) and undergone colonoscopy with polypectomy. Results Of 2417 identified articles, 8 articles (all of them were non-randomized studies of interventions (NRSI); no randomized controlled trials (RCT) were available on this topic) were selected for the meta-analysis, including 1620 patients on antiplatelet therapy and 13,321 controls. Uninterrupted APAs single therapy was associated with an increased risk of PPB compared to the control group (OR 2.31; CI 1.37-3.91). Patients on P2Y12i single therapy had a higher risk of both immediate (OR 4.43; CI 1.40-14.00) and delayed PPB (OR 10.80; CI 4.63-25.16) compared to the control group, while patients on aspirin single therapy may have a little to no difference increase in the number of both immediate and delayed PPB events. Conclusions Uninterrupted single antiplatelet therapy may increase the risk of PPB, but the evidence is very uncertain. The risk may be higher in delayed PPB. However, in deciding to discontinue APAs before colonoscopy with polypectomy, the potential higher risk of major adverse cardiovascular events should always be assessed.
引用
收藏
页码:2258 / 2270
页数:13
相关论文
共 40 条
  • [21] Adverse events related to colonoscopy: Global trends and future challenges
    Kim, Su Young
    Kim, Hyun-Soo
    Park, Hong Jun
    [J]. WORLD JOURNAL OF GASTROENTEROLOGY, 2019, 25 (02) : 190 - 204
  • [22] Risk Analysis of Colorectal Post-Polypectomy Bleeding Due to Antithrombotic Agent
    Kishida, Yoshihiro
    Hotta, Kinichi
    Imai, Kenichiro
    Ito, Sayo
    Yoshida, Masao
    Kawata, Noboru
    Tanaka, Masaki
    Kakushima, Naomi
    Takizawa, Kohei
    Ishiwatari, Hirotoshi
    Matsubayashi, Hiroyuki
    Ono, Hiroyuki
    [J]. DIGESTION, 2019, 99 (02) : 148 - 156
  • [23] Colonoscopic post-polypectomy bleeding in patients on uninterruptedclopidogrel therapy: A systematic review and meta-analysis
    Li, De-Feng
    Chang, Xin
    Fang, Xue
    Wang, Jian-Yao
    Yu, Zhi-Chao
    Wei, Cheng
    Xiong, Feng
    Xu, Zheng-Lei
    Zhang, Ding-Guo
    Liu, Ting-Ting
    Luo, Ming-Han
    Wang, Li-Sheng
    Yao, Jun
    [J]. EXPERIMENTAL AND THERAPEUTIC MEDICINE, 2020, 19 (05) : 3211 - 3218
  • [24] Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication
    Matsumoto, Mio
    Yoshii, Shinji
    Shigesawa, Taku
    Dazai, Masayoshi
    Onodera, Manabu
    Kato, Mototsugu
    Sakamoto, Naoya
    [J]. DIGESTION, 2018, 97 (01) : 76 - 81
  • [25] A review of oral anticoagulants, old and new, in major bleeding and the need for urgent surgery
    Milling, Truman J., Jr.
    Ziebell, Christopher M.
    [J]. TRENDS IN CARDIOVASCULAR MEDICINE, 2020, 30 (02) : 86 - 90
  • [26] Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement (Reprinted from Annals of Internal Medicine)
    Moher, David
    Liberati, Alessandro
    Tetzlaff, Jennifer
    Altman, Douglas G.
    [J]. PHYSICAL THERAPY, 2009, 89 (09): : 873 - 880
  • [27] Prevalence of Aspirin Use for Primary Prevention of Cardiovascular Disease in the United States: Results From the 2017 National Health Interview Survey
    O'Brien, Colin W.
    Juraschek, Stephen P.
    Wee, Christina C.
    [J]. ANNALS OF INTERNAL MEDICINE, 2019, 171 (08) : 596 - +
  • [28] Post-polypectomy bleeding after colonoscopy on uninterrupted aspirin/non steroideal antiflammatory drugs: Systematic review and meta-analysis
    Pigo, Flavia
    Bertani, Helga
    Grande, Giuseppe
    Federica, Abate
    Vavassori, Sara
    Conigliaro, Rita Luisa
    [J]. DIGESTIVE AND LIVER DISEASE, 2018, 50 (01) : 20 - 26
  • [29] RE: Risk of Postpolypectomy Bleeding With Uninterrupted Clopidogrel Therapy in an Industry-Independent, Double-Blind, Randomized, Trial
    Radaelli, Franco
    Mogavero, Giuseppe
    Paggi, Silvia
    [J]. GASTROENTEROLOGY, 2019, 157 (02) : 579 - 579
  • [30] Post-Colonoscopy Complications: A Systematic Review, Time Trends, and Meta-Analysis of Population-Based Studies
    Reumkens, Ankie
    Rondagh, Eveline J. A.
    Bakker, C. Minke
    Winkens, Bjorn
    Masclee, Ad A. M.
    Sanduleanu, Silvia
    [J]. AMERICAN JOURNAL OF GASTROENTEROLOGY, 2016, 111 (08) : 1092 - 1101