Background and study aims: Postpolypectomy bleeding is a rare but serious adverse event. The aim of this study
was to identify factors associated with the risk of severe delayed postpolypectomy
bleeding.
Patients and methods: This was a case-control study, comparing cases who developed hematochezia and required
medical evaluation 6 hours to 14 days after colonoscopic polypectomy, and control
patients who underwent polypectomy without delayed bleeding, and who were selected
in approximately a 3 : 1 ratio. The following risk factors were specified a priori:
resuming anticoagulation (within 1 week following polypectomy), aspirin use, hypertension,
and polyp diameter.
Results: Of the 4592 patients who underwent colonoscopy with polypectomy, 41 patients (0.9
%) developed delayed postpolypectomy bleeding (cases), and 132 patients were selected
as controls. The mean age was 64.3 years for cases and 65.4 years for controls. Cases
presented on average 6 days after polypectomy (range 1 - 14 days), and 48 % required
blood transfusion (average 4.2 units, range 0 - 17). Two patients required surgery.
Anticoagulation was resumed following polypectomy in 34 % of cases compared with 9
% of controls (OR 5.2; 95 % CI 2.2 - 12.5; P < 0.001). For every 1 mm increase in polyp diameter, the risk of hemorrhage increased
by 9 % (OR 1.09; 95 % CI 1.0 - 1.2; P = 0.008). Hypertension (OR 1.1) and aspirin use (OR 1.1) did not increase the risk of
postpolypectomy bleeding. In exploratory analysis, diabetes (OR 2.5) and coronary
artery disease (OR 3.0) were associated with postpolypectomy hemorrhage, but the association
was no longer statistically significant once adjusted for the use of anticoagulation.
Conclusions: Resuming anticoagulation following polypectomy and polyp diameter were strongly associated
with increased risk of severe delayed postpolypectomy bleeding.
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M. S. Sawhney, MD
Section of Gastroenterology
Beth Israel Deaconess Medical Center
RABB-ROSE 101
330 Brookline Avenue
Boston, MA 02215
USA
Fax: +1-617-667-1171
eMail: msawhney@bidmc.harvard.edu