Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Tanisawa, Kawahigashi-machi, Aizuwakamatsu-City, Fukushima, 969-3492, Japan.
Department of Health Data Science Research, Healthy Aging Innovation Center (HAIC), Tokyo Metropolitan Geriatric Medical Center, Tokyo, Japan.
Dig Dis Sci. 2022 May;67(5):1869-1878. doi: 10.1007/s10620-021-06984-6. Epub 2021 May 10.
Cold snare polypectomy is being increasingly adopted; however, there are few reports of cold snare polypectomy regarding antithrombotic therapy.
This study aimed to investigate the real-world safety of cold snare polypectomy during antithrombotic therapy.
We collected data from consecutive patients undergoing cold snare polypectomy in a single hospital between 2013 and 2017. Indications for cold snare polypectomy were any ≤ 10 mm polyp. The primary outcome was delayed bleeding. We compared rates of delayed bleeding between patients with and without antithrombotic therapy and analyzed risk factors for delayed bleeding using binary logistic regression model with firth procedure.
In 2152 patients (mean age 67.6 years; male 1411), 4433 colorectal polyps (mean diameter 5.0 mm) underwent cold snare polypectomy. Clipping during the procedure was performed for 5.8%. Delayed bleeding occurred in 0.51% (11/2152) of patients and 0.25% (11/4433) of polyps, but no major delayed bleeding occurred. A total of 244 (11%) patients received antithrombotic therapy. Patients on antithrombotic therapy were older (p < 0.001), more likely male (p < 0.001) and had cold snare polypectomy in the proximal colon (p = 0.011). The rate of delayed bleeding was higher in patients on antithrombotic therapy (1.64% vs. non-antithrombotic therapy 0.37%, p = 0.009). Larger polyp size (> 5 mm), use of clips, and antithrombotic therapy were significant risk factors for delayed bleeding. There was no clear association between specific antithrombotic agents and delayed bleeding.
Delayed bleeding after cold snare polypectomy was rare even in patients with antithrombotic therapy, and no major delayed bleeding occurred.
冷圈套息肉切除术的应用日益增多，但关于抗血栓治疗的冷圈套息肉切除术的报道较少。
本研究旨在探讨真实世界中抗血栓治疗期间行冷圈套息肉切除术的安全性。
我们收集了 2013 年至 2017 年间在一家医院接受冷圈套息肉切除术的连续患者的数据。冷圈套息肉切除术的适应证为任何 ≤ 10mm 的息肉。主要结局为延迟性出血。我们比较了抗血栓治疗组和无抗血栓治疗组的延迟性出血发生率，并采用二元逻辑回归模型（采用 Firth 程序）分析延迟性出血的危险因素。
在 2152 例患者（平均年龄 67.6 岁；男性 1411 例）中，4433 个结直肠息肉（平均直径 5.0mm）接受了冷圈套息肉切除术。术中夹闭的比例为 5.8%。11/2152（0.51%）例患者和 11/4433（0.25%）个息肉发生延迟性出血，但无严重的延迟性出血。共有 244 例（11%）患者接受了抗血栓治疗。接受抗血栓治疗的患者年龄更大（p < 0.001），更可能为男性（p < 0.001），并且近端结肠进行冷圈套息肉切除术（p = 0.011）。抗血栓治疗组的延迟性出血发生率较高（1.64%比非抗血栓治疗组 0.37%，p = 0.009）。较大的息肉大小（> 5mm）、使用夹闭器和抗血栓治疗是延迟性出血的显著危险因素。特定抗血栓药物与延迟性出血之间没有明确的关联。
即使在接受抗血栓治疗的患者中，冷圈套息肉切除术后也很少发生延迟性出血，且无严重的延迟性出血发生。
