Open Access

Colonoscopic post‑polypectomy bleeding in patients on uninterruptedclopidogrel therapy: A systematic review and meta‑analysis

  • Authors:
    • De‑Feng Li
    • Xin Chang
    • Xue Fang
    • Jian‑Yao Wang
    • Zhi‑Chao Yu
    • Cheng Wei
    • Feng Xiong
    • Zheng‑Lei Xu
    • Ding‑Guo Zhang
    • Ting‑Ting Liu
    • Ming‑Han Luo
    • Li‑Sheng Wang
    • Jun Yao
  • View Affiliations

  • Published online on: March 12, 2020     https://doi.org/10.3892/etm.2020.8597
  • Pages: 3211-3218
  • Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Current guidelines recommend temporary cessation of clopidogrel for 7‑10 days for patients on clopidogrel undergoing colonoscopy with polypectomy. However, recent prospective randomized controlled trials have advocated for uninterrupted clopidogrel, due to similar post‑polypectomy bleeding (PPB) rates with and without continued clopidogrel therapy. Thus, a meta‑analysis was conducted to assess the risk of PPB rate in patients on continued clopidogrel therapy. Systemically identified publications were used to compare the rate of PPB in patients on continued clopidogrel therapy with those who had interrupted clopidogrel therapy. The primary outcome was the incidence of PPB. The secondary outcomes were immediate PPB, delayed PPB and serious cardio‑thrombotic events. This study has been registered in PROSPERO (no. CRD42018118325). A total of five studies were identified, which included 655 patients in the continued clopidogrel group and 6620 patients in the control group. There was an increased risk of PPB with continued clopidogrel [P=0.0003; risk ratio (RR), 1.96; 95% confidence interval (CI), 1.36‑2.83). The rate of immediate PPB was slightly higher in the continued clopidogrel group (5.77% vs. 1.77%, respectively), but was not statistically significant (P=0.06; RR, 1.57; 95%CI, 0.98‑2.51). The rate of delayed PPB was increased in the continued clopidogrel group (P=0.0008; RR, 3.10; 95%CI, 1.60‑5.98). However, no significant difference in serious cardio‑thrombotic events was observed within 30 days (P=0.74; RR, 0.78; 95%CI, 0.18‑3.40). Although continued clopidogrel therapy decreased the incidence of serious cardio‑thrombotic events, the risk of delayed PPB was increased. Therefore, endoscopists should make all preparations to prevent bleeding in the perioperative period for patients at high thrombotic risk and on continued clopidogrel therapy, if polypectomy cannot be reasonably postponed.

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May 2020
Volume 19 Issue 5

Print ISSN: 1792-0981
Online ISSN:1792-1015

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APA
Li, D., Chang, X., Fang, X., Wang, J., Yu, Z., Wei, C. ... Yao, J. (2020). Colonoscopic post‑polypectomy bleeding in patients on uninterruptedclopidogrel therapy: A systematic review and meta‑analysis. Experimental and Therapeutic Medicine, 19, 3211-3218. https://doi.org/10.3892/etm.2020.8597
MLA
Li, D., Chang, X., Fang, X., Wang, J., Yu, Z., Wei, C., Xiong, F., Xu, Z., Zhang, D., Liu, T., Luo, M., Wang, L., Yao, J."Colonoscopic post‑polypectomy bleeding in patients on uninterruptedclopidogrel therapy: A systematic review and meta‑analysis". Experimental and Therapeutic Medicine 19.5 (2020): 3211-3218.
Chicago
Li, D., Chang, X., Fang, X., Wang, J., Yu, Z., Wei, C., Xiong, F., Xu, Z., Zhang, D., Liu, T., Luo, M., Wang, L., Yao, J."Colonoscopic post‑polypectomy bleeding in patients on uninterruptedclopidogrel therapy: A systematic review and meta‑analysis". Experimental and Therapeutic Medicine 19, no. 5 (2020): 3211-3218. https://doi.org/10.3892/etm.2020.8597