Veeravich Jaruvongvanich1,2, Buravej Assavapongpaiboon2, Karn Wijarnpreecha3, Patompong Ungprasert4,5. 1. Department of Internal Medicine, University of Hawaii, Honolulu, USA. 2. Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 3. Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, USA. 4. Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, USA. 5. Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract
BACKGROUND AND AIM: Peri-procedural bridging (PPB) with heparin is recommended for patients with high thromboembolic risk who need to withhold antithrombotic therapy for colonoscopic polypectomy. However, little is known about the bleeding risk from heparin-bridging therapy itself. METHODS: MEDLINE and EMBASE databases were searched through January 2017 for studies that compared the risk of PPB in patients who received heparin-bridging therapy in lieu of antithrombotic agents for colonoscopic polypectomy and those who discontinued antithrombotic agents without receiving heparin. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model, generic inverse variance method. Between-study heterogeneity was quantified using the Q statistic and I2 . RESULTS: A total of five studies consisting of 2601 patients were identified. A significantly increased risk of PPB among bridged patients compared to non-bridged patients was demonstrated with a pooled OR of 8.29 (95% CI, 4.96-13.87). Statistical heterogeneity was low with I2 of 0%. CONCLUSION: The present study demonstrated a significantly increased risk of PPB among patients who underwent colonoscopic polypectomy and received heparin-bridging therapy in lieu of antithrombotic agents compared to patients who did not receive it.
BACKGROUND AND AIM: Peri-procedural bridging (PPB) with heparin is recommended for patients with high thromboembolic risk who need to withhold antithrombotic therapy for colonoscopic polypectomy. However, little is known about the bleeding risk from heparin-bridging therapy itself. METHODS: MEDLINE and EMBASE databases were searched through January 2017 for studies that compared the risk of PPB in patients who received heparin-bridging therapy in lieu of antithrombotic agents for colonoscopic polypectomy and those who discontinued antithrombotic agents without receiving heparin. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model, generic inverse variance method. Between-study heterogeneity was quantified using the Q statistic and I2 . RESULTS: A total of five studies consisting of 2601 patients were identified. A significantly increased risk of PPB among bridged patients compared to non-bridged patients was demonstrated with a pooled OR of 8.29 (95% CI, 4.96-13.87). Statistical heterogeneity was low with I2 of 0%. CONCLUSION: The present study demonstrated a significantly increased risk of PPB among patients who underwent colonoscopic polypectomy and received heparin-bridging therapy in lieu of antithrombotic agents compared to patients who did not receive it.