La terapia bridge con eparina aumenta il rischio di sanguinamento post-polipectomia

Risk factors for postpolypectomy bleeding in patients receiving anticoagulation or antiplatelet medications.Lin D1, Soetikno RM, McQuaid K, Pham C, Doan G, Mou S, Shergill AK, Somsouk M, Rouse RV, Kaltenbach T. Gastrointest Endosc. 2017 Dec 2. [Epub ahead of print]

BACKGROUND AND AIMS: Balancing the risks for thromboembolism and postpolypectomy bleeding in patients requiring anticoagulation and antiplatelet agents is challenging. We investigated the incidence and risk factors for postpolypectomy bleeding on anticoagulation, including heparin bridge, and other antithrombotic therapy.

METHODS: We performed a retrospective cohort and case control study at 2 tertiary care medical centers from 2004 to 2012. Cases included male patients on antithrombotics with hematochezia after polypectomy. Nonbleeding controls were matched to cases 3 to 1 by antithrombotic type, study site, polypectomy technique, and year of procedure. Our outcomes were the incidence and risk factors for postpolypectomy bleeding RESULTS: There were 59 cases and 174 matched controls. Postpolypectomy bleeding occurred in 14·9% on bridge anticoagulation. This was significantly higher than the overall incidence of bleeding on antithrombotics at 1·19% (95% CI, 0·91 - 1·54%) (59/4923). We identified similarly low rates of bleeding on warfarin (0·66%), clopidogrel (0·84%), and aspirin (0·92%). Patients who bled tended to have larger polyps (13·9 vs. 7·3mm, p<0·001) and more polyps ≥2cm (41 vs. 10%, p<0·001). Bleeding risk was increased with restarting antithrombotics within one week postpolypectomy (OR 4·50, p<0·001), having polyps ≥2cm (OR 5·94, p<0·001), performing right-sided cautery (OR 2·61, p=0·004), and having multiple large polyps (OR 2·92, p=0·001). Among patients on warfarin, the presence of bridge anticoagulation was an independent risk factor for postpolypectomy bleeding (OR 12·27, p=0·0001).CONCLUSIONS: We conclude that bridge anticoagulation is associated with a high incidence of postpolypectomy bleeding and is an independent risk factor for hemorrhage compared with those on warfarin alone. A higher threshold to use bridge anticoagulation should be considered in patients with an elevated bleeding risk.

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