Document Detail


Risk factors for severe delayed postpolypectomy bleeding.
MedLine Citation:
PMID:  18253906     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
M S Sawhney; N Salfiti; D B Nelson; F A Lederle; J H Bond
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Endoscopy     Volume:  40     ISSN:  1438-8812     ISO Abbreviation:  Endoscopy     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-06     Completed Date:  2008-03-20     Revised Date:  2009-06-17    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  115-9     Citation Subset:  IM    
Affiliation:
Section of Gastroenterology Minneapolis Veterans Administration Medical Center, Minneapolis, USA. msawhney@bidmc.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Biopsy, Needle
Case-Control Studies
Colonic Polyps / pathology,  surgery*
Colonoscopy / adverse effects*,  methods
Female
Follow-Up Studies
Hemostasis, Endoscopic / methods*
Humans
Immunohistochemistry
Incidence
Male
Middle Aged
Odds Ratio
Postoperative Hemorrhage / diagnosis*,  epidemiology,  therapy
Probability
Reference Values
Risk Factors
Severity of Illness Index
Time Factors
Comments/Corrections
Comment In:
Endoscopy. 2009 Jun;41(6):572   [PMID:  19533568 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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