582 Resuming Nonaspirin Antiplatelet Agents Is Not a Risk Factor for Bleeding After Endoscopic Resection of Colorectal Lesions

Resuming Nonaspirin Antiplatelet Agents Is Not a Risk Factor for Bleeding After Endoscopic Resection of Colorectal Lesions Kazuko Beppu*, Naoto Sakamoto, Taro Osada, Kenshi Matsumoto, Tomoyoshi Shibuya, Akihito Nagahara, Tatsuo Ogihara, Sumio Watanabe Gastroenterology, Juntendo University, Tokyo, Japan Background and Aim: The prevalence of cardiovascular diseases treated by coronary stents (especially those with Drug Eluting Stent) has been rising worldwide. Nonaspirin antiplatelet agents such as thienopyridines (clopidogrel, ticlopidine), which inhibit platelet activation, adhesion, or aggregation, are used in the management of coronary artery diseases. The subsequent increase in consumption of anticoagulants and thienopyridines now brings into question whether resuming these medical therapies after temporarily discontinuing them for endoscopic resection furthers the risk of delayed bleeding. However, guidelines are not rules, and there are currently little data on this issue. The aim of this study was to investigate whether restarting anticoagulants and/or thienopyridines induces delayed bleeding after endoscopic resection. Method: We performed a case-control study of patients who had endoscopic resection at our hospital from January 2006 to October 2012. Our database revealed 52 cases of post-endoscopic treatment bleeding among 1970 cases with polyps larger than 10 mm that were removed by polypectomy, endoscopic mucosal resection or endoscopic submucosal dissection. We randomly selected from our database 156 non-bleeding cases with polyps larger than 10mm matched for age and gender as controls. We investigated patient-related factors (resuming anticoagulants, resuming thienopyridines, hypertension, diabetes mellitus) and polyp-related factors (morphology, size, location, resection technique, pathology) by univariate and multivariate logistic regression analysis. Antithrombotic agents were resumed within 5 days following endoscopic resection. Results: The bleeding cases were aged 59.5 11.6 years (mean SD), and 85% were males. 50 cases required endoscopic hemostasis and 2 required blood transfusions. By univariate analysis, anticoagulation treatment with warfarin and/or dabigatran and/or heparin was resumed within 5 days following endoscopic resection in 23% of bleeding cases compared with 6% of control cases (OR 4.9; 95%CI 1.9-12.4; p 0.0003). Thienopyridines were not found to be a significant risk factor for delayed bleeding (OR 1.8; 95%CI 0.5-6.3; p 0.37). No significant differences were found in resection technique (OR 1.1; 95%CI 0.5-2.1; p 0.86) and polyp size (OR 1.3; 95%CI 0.6-2.6; p 0.47). Multivariate analysis of factors influencing bleeding indicated that a significant and independent risk factor was resuming anticoagulants (OR 8.2; 95%CI 2.5-27.1; p 0.0005). Conclusions: Resuming anticoagulants after endoscopic resection was an independent risk factor for and strongly associated with severe delayed bleeding whereas resuming thienopyridines was not associated with delayed bleeding. Therefore, it is critical that cases being treated with anticoagulants be monitored with particular care. 583 Randomized Controlled Trial (RCT) of Hemoclip Closure of Post-Polypectomy Induced Ulcers (Ppiu’s) for Prevention of Delayed Hemorrhage in Patients on Chronic Warfarin: Initial Results, Techniques, & Recommendations Dennis M. Jensen*, Kevin a. Ghassemi, Gordon V. Ohning, Thomas O. Kovacs CURE Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, Los Angeles, CA; Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Medicine Gastroenterology, Ronald Reagan UCLA Medical Center, Los Angeles, CA Background & Purpose: Retrospective reports estimate the risk of severe delayed PPIU hemorrhage (H) in patients on chronic warfarin is about 10 X that of other patients. Although no prospective RCT data confirm this risk, many endoscopists are prophylactically using hemoclips (HC’s) after colon polypectomies to potentially reduce delayed PPIUH in such patients. Our purposes in this RCT in patients on warfarin are to report: 1. prevalences with & without colon polyps after informed consent, 2. techniques & results of PPIU closure in HC patients, & 3. 30 day outcomes. Methods: Written informed consent on an IRB approved blinded RCT (e.g. patient & primary care physician blinded) was obtained in patients on chronic warfarin for severe co-morbidities prior to screening or surveillance colonoscopy at 2 referral centers. The anticoagulation schedule was managed in all patients using current ASGE guidelines. Patients with 1-6 polyps & PPIU’s between 5 15 mm were randomized to control vs. HC closure. Location & # of polyps, PPIU size, decrease in Hgb, clinical bleeding, abdominal pain, & other complications were prospectively evaluated up to 30 days in all patients. For HC patients, # of HC’s/PPIU & success/failure of HC closure were recorded. Results: 30 patients on chronic warfarin were referr ...