Heparin-bridging therapy is associated with post-colorectal polypectomy bleeding in patients whose oral anticoagulation therapy is interrupted

Abstract

Objectives: The American and Japanese Societies for Gastrointestinal Endoscopy Guidelines recommend heparin-bridging therapy for patients whose oral anticoagulants are interrupted for endoscopic procedures. However, little is known about the potential association between heparin-bridging therapy and post-polypectomy bleeding (PPB). The aim was to investigate the incidence of PPB associated with heparin-bridging therapy administered to patients whose anticoagulants were interrupted.

Materials and methods: This was a retrospective observational study using inverse propensity analysis. Between 2013 and 2015, 1004 patients with 2863 lesions were included. The primary outcomes were the rates of PPB and thromboembolism associated with heparin-bridging therapy. The risk factors associated with PPB were identified using multivariate logistic regression analysis involving probability of treatment weighting (IPTW).

Results: The patients were categorized into a heparin-bridging therapy group (78 patients with 255 lesions) or a control group (926 patients with 2608 lesions). The PPB rate in the heparin-bridging therapy group (10.2%, 8/78) was significantly higher than in the control group (1.1%, 11/926) (p <.01). Thromboembolism occurred in one patient in the control group. The multivariate analysis revealed that heparin-bridging therapy was an independent risk factor associated with PPB (odds ratio [OR], 8.21; 95% confidence interval [95% CI], 2.32–29.10; p <.01). IPTW showed heparin-bridging therapy increased PPB (OR, 7.68; 95% CI, 1.83–32.28; p <.01).

Conclusions: Heparin-bridging therapy administered to patients whose oral anticoagulants were interrupted was associated with an increased PPB risk.

Keywords:

• Colon polyp
• anticoagulant
• heparin-bridging therapy
• polypectomy
• propensity score
• inverse probability of treatment weighting (IPTW)

Acknowledgements

We would like to thank Editage (www.editage.jp) for their English language editing.

The authors thank Drs. Kappei Hayashi, Yosuke Kinoshita, Hirotsugu Maruyama, Kunihiro Kato, Hiroaki Minamino, Koji Otani, Shuhei Hosomi, Fumio Tanaka, Koichi Taira, Noriko Kamata, and Tetsuya Tanigawa for their excellent advice.

Disclosure statement

Drs. Tetsuya Tanigawa, Toshio Watanabe, and Yasuhiro Fujiwara are faculty members of a course sponsored by EA pharma Co., Ltd. Dr. Yasuhiro Fujiwara received research grants from Ono. Drs. Sakai, Nagami, Shiba, Hayashi, Kinoshita, Maruyama, Kato, Minamino, Ominami, Fukunaga, Otani, Hosomi, Tanaka, Taira, Kamata, Yamagami declare that they have no conflicts of interest.