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CC BY 4.0 · TH Open 2024; 08(02): e216-e223
DOI: 10.1055/s-0044-1787553
Original Article

Periprocedural Anticoagulation Management of Patients Undergoing Colonoscopy with Polypectomy

Melissa Chan‡   *
1   Department of Medicine, University of British Columbia, Vancouver, Canada
,
Joshua Yoon‡   *
1   Department of Medicine, University of British Columbia, Vancouver, Canada
,
Jennifer J. Telford
1   Department of Medicine, University of British Columbia, Vancouver, Canada
2   Division of Gastroenterology, University of British Columbia, Vancouver, Canada
3   British Columbia Colon Screening Program, BC Cancer, Vancouver, Canada
,
Chipman T. Drury‡   *
1   Department of Medicine, University of British Columbia, Vancouver, Canada
4   Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
,
Tony Wan‡   *
1   Department of Medicine, University of British Columbia, Vancouver, Canada
4   Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
› Author Affiliations Funding None.
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Abstract

Introduction/Objective Colonoscopy with polypectomy is an integral component of colorectal cancer screening. There are limited data and consensus on periprocedural anticoagulation management, especially regarding bleeding risk with uninterrupted anticoagulation and thromboembolic risk with interruption. Our aim was to determine the incidence of bleeding and thromboembolic complications among colon screening participants undergoing colonoscopy following implementation of a novel patient care pathway for standardized periprocedural anticoagulation management.

Methods We conducted a retrospective study including all participants (age 50–74) on an oral anticoagulant (e.g., vitamin K antagonists, direct oral anticoagulants) referred to the British Columbia Colon Screening Program for colonoscopy following abnormal fecal immunochemical test in a 6-month period (March–August 2022). Data relating to their specific periprocedural anticoagulant management and colonoscopy results including method of polypectomy were obtained. Primary outcomes were major bleeding and arterial or venous thromboembolic events from time of oral anticoagulant interruption until 14 days of postcolonoscopy. Secondary outcomes included nonmajor and minor bleeding, acute coronary syndrome, emergency room visit, hospital admission, and death due to any cause.

Results Over the 6-month period, 162 participants completed standardized periprocedural anticoagulation management, colonoscopy ± polypectomy, and 14-day follow-up. One (0.6%) had a major bleeding event and one (0.6%) had an arterial thromboembolic event.

Conclusions A novel patient care pathway for standardized periprocedural anticoagulation management with a multidisciplinary team is associated with low rates of major bleeding and thrombotic complications after colonoscopy with polypectomy.

Keywords

colonoscopy - polypectomy - anticoagulation - periprocedural management

Ethics Approval

The University of British Columbia Research Ethics Board approved this study.


Author Contributions

M.C., J.Y., J.J.T., C.T.D., T.W.: concept and design. M.C., J.Y., J.J.T., C.T.D., T.W.: analysis and interpretation of data. M.C., J.Y., C.T.D., T.W.: drafting of manuscript. M.C., J.Y., J.J.T., C.T.D., T.W.: critical revision of the manuscript for important intellectual content. C.T.D., T.W.: statistical analysis. T.W.: guarantor of the article. The first draft of the manuscript was written by the first, second, and last authors. All authors approved the final version of the manuscript.


* Equal contribution and co-authorship.




Publication History

Received: 03 March 2024

Accepted: 06 May 2024

Article published online:
03 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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