Effect of antiplatelet agent number, types, and pre-endoscopic management on post-polypectomy bleeding: validation of endoscopy guidelines
| Autor: | Naomi Uemura, Junichi Akiyama, Takuro Shimbo, Akio Kimura, Naohiro Yanagisawa, Mikio Yanase, Naoyoshi Nagata, Koh Imbe, Chizu Yokoi, Hidetaka Okubo, Kazuhiro Watanabe |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Thienopyridine medicine.medical_treatment Colonic Polyps Hemorrhage Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Aged Retrospective Studies Aspirin business.industry Endoscopy Odds ratio Polypectomy Cilostazol Beraprost Dipyridamole 030220 oncology & carcinogenesis Concomitant 030211 gastroenterology & hepatology Surgery Female business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Surgical endoscopy. 35(1) |
| ISSN: | 1432-2218 |
| Popis: | It remains unclear whether type of antiplatelet (AP) therapy, AP combination therapy, and AP continuing or switching strategy affect the risk of post-polypectomy bleeding (PPB). In this study, we sought to elucidate this risk. We analyzed 1050 patients who underwent colonoscopic polypectomy: 525 AP users and 525 controls matched for age, sex, comorbidities, concomitant non-steroidal anti-inflammatory drugs use, and polyp characteristics who did not receive antithrombotics. PPB risk was evaluated by AP number, type, and continuing or switching strategies during the peri-endoscopic period. In multivariate analysis, bleeding risk increased significantly as the number of AP agents used increased (monotherapy, adjusted odds ratio [aOR], 3.7; dual antiplatelet therapy (DAPT), 4.6; triple antiplatelet therapy (TAPT), 11.1) compared with controls. With monotherapy, significantly increased PPB risk was found for aspirin (aOR 4.3), thienopyridine (aOR 6.3), and cilostazol (aOR 5.9), but not for eicosapentaenoic acid or other APs (beraprost, limaprost, sarpogrelate, dilazep, or dipyridamole). With DAPT, significantly increased PPB risk was found for combination aspirin plus cilostazol, but not aspirin plus other APs. Bleeding rates for continuing monotherapy were 4.3% for aspirin and 0% for thienopyridine, cilostazol, and other APs, respectively. Analysis of this large polypectomy dataset showed that the use of low-dose aspirin, thienopyridine, or cilostazol and a combination of these is associated with increased PPB risk. Although PPB risk was high with DAPT or TAPT, PPB rate in any antiplatelet monotherapy even with a continuing strategy was low at |
| Databáze: | OpenAIRE |
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