医学
氯吡格雷
阿司匹林
息肉切除术
内科学
粘膜切除术
腹部外科
观察研究
逻辑回归
内窥镜检查
外科
胃肠病学
结肠镜检查
麻醉
结直肠癌
癌症
作者
Sang Min Park,Soo-Kyung Park,Hyo-Joon Yang,Yoon Suk Jung,Jung Tak Park,Chong Il Sohn,Dong Il Park
标识
DOI:10.1007/s00464-021-08987-w
摘要
BackgroundCurrent guidelines recommend continuing aspirin and discontinuing clopidogrel for colon polypectomy, but evidence for endoscopic mucosal resection (EMR) is insufficient. We aimed to assess post-polypectomy bleeding (PPB) in patients receiving antiplatelet agents and underwent EMR for various polyp sizes.MethodsA single-center, prospective observational study was performed. Patients who underwent at least one EMR for polypectomy and those who received aspirin or clopidogrel were included. We compared PPB between the antiplatelet hold group (stopped antiplatelet therapy at least 5 days before the procedure) and continue group (antiplatelet therapy was maintained or stopped within 5 days before the procedure).ResultsAmong patients who underwent EMR, 305 took aspirin (hold group 257, continue group 48) and 77 took clopidogrel (hold group 66, continue group 11). The mean number of polyps was four, and the mean size was 8.6 mm. There was no difference in the major PPB rate between the hold and continue groups among aspirin users (2.0% vs. 4.2%, P = 0.30), but it was significantly higher in the continue group than in the hold group among clopidogrel users (18.2% vs. 0%, P = 0.02). In patient- and polyp-based logistic regression analysis of clopidogrel users, the number of EMRs (OR 2.12, 95% CI 1.16–3.88), polyp size (OR 1.26, 95% CI 1.06–1.49), and continuing clopidogrel (OR 9.75, 95% CI 1.99–47.64) were independent risk factors for PPB.ConclusionContinuous administration of antiplatelet agents was significantly associated with higher PPB in clopidogrel users, but not in aspirin users. Endoscopists should consider holding clopidogrel if the EMR includes polypectomy.
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