PMID- 32030553
OWN - NLM
STAT- MEDLINE
DCOM- 20210625
LR  - 20210625
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 35
IP  - 1
DP  - 2021 Jan
TI  - Effect of antiplatelet agent number, types, and pre-endoscopic management on 
      post-polypectomy bleeding: validation of endoscopy guidelines.
PG  - 317-325
LID - 10.1007/s00464-020-07402-0 [doi]
AB  - BACKGROUND: 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. 
      METHODS: 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. RESULTS: 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. CONCLUSIONS: 
      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 < 5%.
FAU - Watanabe, Kazuhiro
AU  - Watanabe K
AD  - Department of Gastroenterology and Hepatology, National Center for Global Health 
      and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
AD  - Course of Advanced and Specialized Medicine, Juntendo University Graduate School 
      of Medicine, Tokyo, Japan.
FAU - Nagata, Naoyoshi
AU  - Nagata N
AD  - Department of Gastroenterology and Hepatology, National Center for Global Health 
      and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. 
      nnagata_ncgm@yahoo.co.jp.
AD  - Department of Gastroenterological Endoscopy, Tokyo Medical University, 6-7-1 
      Nishishinjuku, Shinju-ku, Tokyo, 162-0023, Japan. nnagata_ncgm@yahoo.co.jp.
FAU - Yanagisawa, Naohiro
AU  - Yanagisawa N
AD  - Department of Gastroenterology and Hepatology, National Center for Global Health 
      and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
FAU - Shimbo, Takuro
AU  - Shimbo T
AD  - Ohta Nishinouchi Hospital, Fukushima, Japan.
FAU - Okubo, Hidetaka
AU  - Okubo H
AD  - Department of Gastroenterology and Hepatology, National Center for Global Health 
      and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
FAU - Imbe, Koh
AU  - Imbe K
AD  - Department of Gastroenterology and Hepatology, National Center for Global Health 
      and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
FAU - Yokoi, Chizu
AU  - Yokoi C
AD  - Department of Gastroenterology and Hepatology, National Center for Global Health 
      and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
FAU - Yanase, Mikio
AU  - Yanase M
AD  - Department of Gastroenterology and Hepatology, National Center for Global Health 
      and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
FAU - Kimura, Akio
AU  - Kimura A
AD  - Course of Advanced and Specialized Medicine, Juntendo University Graduate School 
      of Medicine, Tokyo, Japan.
AD  - Department of Emergency and Critical Medicine, National Center for Global Health 
      and Medicine, Tokyo, Japan.
FAU - Akiyama, Junichi
AU  - Akiyama J
AD  - Department of Gastroenterology and Hepatology, National Center for Global Health 
      and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
FAU - Uemura, Naomi
AU  - Uemura N
AD  - Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center 
      for Global Health and Medicine, Chiba, Japan.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200206
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Aged
MH  - Colonic Polyps/*complications/*surgery
MH  - Endoscopy/*methods
MH  - Female
MH  - Hemorrhage/*drug therapy
MH  - Humans
MH  - Male
MH  - Platelet Aggregation Inhibitors/pharmacology/*therapeutic use
MH  - Retrospective Studies
OTO - NOTNLM
OT  - ASGE guidelines
OT  - Delayed bleeding
OT  - Dual antiplatelet therapy (DAPT)
OT  - ESGE guidelines
OT  - JGES guidelines
OT  - acetylsalicylic acid
EDAT- 2020/02/08 06:00
MHDA- 2021/06/29 06:00
CRDT- 2020/02/08 06:00
PHST- 2019/01/15 00:00 [received]
PHST- 2020/01/30 00:00 [accepted]
PHST- 2020/02/08 06:00 [pubmed]
PHST- 2021/06/29 06:00 [medline]
PHST- 2020/02/08 06:00 [entrez]
AID - 10.1007/s00464-020-07402-0 [pii]
AID - 10.1007/s00464-020-07402-0 [doi]
PST - ppublish
SO  - Surg Endosc. 2021 Jan;35(1):317-325. doi: 10.1007/s00464-020-07402-0. Epub 2020 
      Feb 6.