Is it reasonable to perform polypectomy without interruption of anticoagulation?

Currently, patients taking anticoagulants to prevent stroke and blood clots are often recommended to stop these medications in order to perform colonoscopy with removal of polyps.

However, interruption of these medications can place patients at risk of stroke and blood clots. A group led by Shai Friedland at the VA Palo Alto hospital in California reported their experience removing small colon polyps without interrupting anticoagulation. Their study will be published on April 28, 2009 in the World Journal of Gastroenterology

Two hundred and twenty five polypectomies were performed in 123 patients. Patients followed a standardized protocol that included stopping warfarin for 36 h to avoid supratherapeutic anticoagulation from the bowel preparation. Patients with lesions larger than 1 cm were generally rescheduled for polypectomy off warfarin. Endoscopic clips were routinely applied prophylactically.

They reported that one patient (0.8%, 95% CI: 0.1%-4.5%) developed major post-polypectomy bleeding that required transfusion. Two others (1.6%, 95% CI: 0.5%-5.7%) had self-limited hematochezia at home and did not seek medical attention. The average polyp size was 5.1 +/- 2.2 mm. They announced that polypectomy can be performed in therapeutically anticoagulated patients with lesions up to 1 cm in size with an acceptable bleeding rate.

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