Meta-analysis: colonoscopic post-polypectomy bleeding in patients on continued clopidogrel therapy

S Gandhi, N Narula, W Mosleh, J K Marshall, M Farkouh
Alimentary Pharmacology & Therapeutics 2013, 37 (10): 947-52

BACKGROUND: Current guidelines recommend the cessation of clopidogrel therapy 5 days and 7-10 days prior to colonoscopic polypectomy. Recent studies have advocated for continued clopidogrel as post-polypectomy bleeding (PPB) rates have been similar to those in the general population not on antithrombotic therapy.

AIM: To assess colonoscopic post-polypectomy bleeding in patients on continued clopidogrel therapy.

METHODS: A literature search was conducted for studies that investigated PPB in patients on continued clopidogrel therapy. The primary outcome of interest was the pooled relative risk ratio (RR) of colonoscopic PPB in patients on continued clopidogrel therapy vs. controls. Secondary outcomes were a comparison of immediate and delayed colonoscopy PPB in patients on continued clopidogrel therapy vs. controls.

RESULTS: Five observational studies included 574 subjects on continued clopidogrel therapy and 6169 control subjects. The pooled RR for PPB on continued clopidogrel therapy was 2.54 (95% CI 1.68-3.84, P < 0.00001). For immediate PPB there was a nonsignificant pooled RR of 1.76 (95% CI 0.90-3.46, P = 0.10), and delayed PPB there was a significant pooled RR of 4.66 (95% CI 2.37-9.17, P < 0.00001).

CONCLUSIONS: The results of this meta-analysis suggest that continued clopidogrel increases the risk of delayed but not immediate post-polypectomy bleeding. Clopidogrel interruption in individuals with coronary artery disease predisposes to serious acute ischaemic events. In high-risk patients, endoscopists should be cognisant of these risks and consider deferring elective colonoscopy and polypectomy until it is considered safe to interrupt clopidogrel therapy.

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