An-Najah National University Coralville, IA, United States
Award: Presidential Poster Award
Dana Ghazaleh, MD1, Ziad Abuhelwa, MD2, Wasef Sayeh, MD2, Saif-Eddin Malhas, MD2, Azizullah Beran, MD3, Yasmin Khader, MD2, Sami Ghazaleh, MD3 1An-Najah National University, Coralville, IA; 2University of Toledo, Toledo, OH; 3University of Toledo Medical Center, Toledo, OH
Introduction: Post-polypectomy bleeding (PPB) is a known complication of colonoscopic polypectomy, ranging from 0.3% to 3.6% per patient. This can be categorized into immediate and delayed. Clopidogrel has been used broadly to decrease cardio-thrombotic incidents. Physicians should carefully weigh the risks of continuing clopidogrel during polypectomy against the risks of stopping it. There is still a lack of data regarding the safety of clopidogrel during endoscopic polypectomy.
Methods: We conducted a meta-analysis of studies that investigated the colonoscopic PPB rates in patients on continued clopidogrel compared to controls (either not taking clopidogrel or who held it at least five days prior to the procedure). A systemic search was performed to retrieve the studies from inception to May 2021 via the PubMed/MEDLINE database and Cochrane library. We defined immediate PPB as intraprocedural and delayed PPB as postprocedural (up to 30 days). The primary outcome was the incidence of total PPB. The secondary outcomes were immediate PPB, delayed PPB and the occurrence of cardio-thrombotic events. The random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). A p-value < 0.05 was considered statistically significant.
Results: A total of seven studies were identified, four were RCTs, and three were retrospective cohort studies. The studies included 729 patients in the continued clopidogrel group and 7063 patients in the control group. The risk of total PPB was significantly higher in those who continued clopidogrel (RR 1.85, 95% CI 1.34- 2.57, p 0.0002, I2= 0%). There was a significantly increased rate of immediate PPB in the continued clopidogrel group (RR 1.85, 95% CI 1.16- 2.95, p 0.009 I2= 6%). As of delayed PPB, there was no statically significant difference between the two groups (RR 2.22, 95% CI 0.91- 5.43, p 0.08, I2=51%). There was no statistically significant difference between the two groups in terms of cardio-thrombotic events (RR 0.80, 95% CI 0.22-2.93, p 0.74, I2= 0%).
Discussion: This meta-analysis revealed that continuing clopidogrel significantly increased the risk of total and immediate PPB, but not delayed PPB or cardio-thrombotic events. Therefore, endoscopists should be cognizant of these risks and make the necessary precautions in the peri-operative period. Additional larger studies are warranted to further define the optimal management of patients on clopidogrel undergoing colonoscopic polypectomies.
Figure: a. Total PPB b. Immediate PPB c. Delayed PPB d. Cardio-thrombotic events
Disclosures: Dana Ghazaleh indicated no relevant financial relationships. Ziad Abuhelwa indicated no relevant financial relationships. Wasef Sayeh indicated no relevant financial relationships. Saif-Eddin Malhas indicated no relevant financial relationships. Azizullah Beran indicated no relevant financial relationships. Yasmin Khader indicated no relevant financial relationships. Sami Ghazaleh indicated no relevant financial relationships.
Dana Ghazaleh, MD1, Ziad Abuhelwa, MD2, Wasef Sayeh, MD2, Saif-Eddin Malhas, MD2, Azizullah Beran, MD3, Yasmin Khader, MD2, Sami Ghazaleh, MD3. P0463 - Colonoscopic Post-Polypectomy Bleeding in Patients on Continued Clopidogrel Therapy: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
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