Patients on Uninterrupted Clopidogrel Not at Increased Risk for Bleeding during Post-polypectomy

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The side effects that may occur as a result of stopping clopidogrel are much more serious than the slightly increased bleeding risk that patients on clopidogrel are faced with.

A study from the Syracuse Veterans Affairs Medical Center in New York examined post-polypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel. According to a press release from the American Society for Gastrointestinal Endoscopy (ASGE), the researchers found that, while the post-polypectomy bleeding rate is significantly higher in patients who are also taking clopidogrel and concomitant aspirin/nonsteroidal anti- inflammatory drugs, this risk is small and the overall outcome of the procedure is favorable.

The study, results of which were also published in the May issue of Gastrointestinal Endoscopy, was initiated because the primary concern for most endoscopists performing interventional procedures is the potential risk for increased bleeding afterward. The potential for thromboembolitic events is also a concern, according to the ASGE, which can “pose a substantial, even life-threatening, risk to the patient whose anticoagulation therapy is interrupted.”

To learn more, the researchers performed a retrospective study of patients who underwent a colonoscopy with or without a polypectomy on uninterrupted clopidogrel therapy between January 2002 and October 2007. The researchers divided participants into two groups: “Group A (cases) included 142 patients who underwent polypectomy and 77 underwent colonoscopy without a polypectomy. Group B (controls) comprised 1,243 randomly selected patients who had undergone colonoscopic polypectomy but were not receiving clopidogrel therapy.” A total of 46 patients, 8 in Group A and 38 in Group B, experienced bleeding after the polypectomy. The immediate (intraprocedural) bleeding rate was similar between both groups, but the post-procedural bleeding rate was higher for the group taking clopidogrel (3.5% vs. 1.0%). However, the researchers also found that stopping clopidogrel in individuals with cardiovascular and atherothrombotic diseases predisposed them to acute ischemic events, which are much more serious.

The researchers conclude that, while clopidogrel does increase post-polypectomy bleeding rates, the risk is limited and stopping clopidogrel poses much more serious risks.

“The risk [of increased bleeding] is small and the outcome is favorable,” the authors concluded in Gastrointestinal Endoscopy. “Routine cessation of clopidogrel in patients before colonoscopy/polypectomy is not necessary.”

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