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Continuous Anticoagulation and Cold Snare Polypectomy Versus Heparin Bridging and Hot Snare Polypectomy in Patients on Anticoagulants With Subcentimeter Polyps: A Randomized Controlled Trial.
Takeuchi, Yoji; Mabe, Katsuhiro; Shimodate, Yuichi; Yoshii, Shinji; Yamada, Shinya; Iwatate, Mineo; Kawamura, Takuji; Hotta, Kinichi; Nagaike, Koji; Ikezawa, Nobuaki; Yamasaki, Tomoaki; Komeda, Yoriaki; Asai, Satoshi; Abe, Yasuhiro; Akamatsu, Takuji; Sakakibara, Yuko; Ikehara, Hisatomo; Kinjo, Yuzuru; Ohta, Takashi; Kitamura, Yoko; Shono, Takashi; Inoue, Takuya; Ohda, Yoshio; Kobayashi, Nozomu; Tanuma, Tokuma; Sato, Ryu; Sakamoto, Taku; Harada, Naohiko; Chino, Akiko; Ishikawa, Hideki; Nojima, Masanori; Uraoka, Toshio.
Afiliação
  • Takeuchi Y; Osaka International Cancer Institute, Osaka, Japan (Y.T.).
  • Mabe K; National Hospital Organization Hakodate National Hospital, Hakodate, Japan (K.M.).
  • Shimodate Y; Kurashiki Central Hospital, Kurashiki, Japan (Y.S.).
  • Yoshii S; Sapporo Medical Center Nippon Telegraph and Telephone East Corporation, Sapporo, Japan (S.Y.).
  • Yamada S; Ishikawa Prefectural Central Hospital, Kanazawa, Japan (S.Y.).
  • Iwatate M; Sano Hospital, Kobe, Japan (M.I.).
  • Kawamura T; Kyoto Second Red Cross Hospital, Kyoto, Japan (T.K.).
  • Hotta K; Shizuoka Cancer Center, Suntogun, Shizuoka, Japan (K.H.).
  • Nagaike K; Suita Municipal Hospital, Suita, Japan (K.N.).
  • Ikezawa N; Akashi Medical Center, Akashi, Japan (N.I.).
  • Yamasaki T; Osaka City General Hospital, Osaka, Japan (T.Y.).
  • Komeda Y; Kindai University Faculty of Medicine, Osaka-Sayama, Japan (Y.K.).
  • Asai S; Tane General Hospital, Osaka, Japan (S.A.).
  • Abe Y; Utsunomiya Memorial Hospital, Tochigi, Japan (Y.A.).
  • Akamatsu T; Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan (T.A.).
  • Sakakibara Y; National Hospital Organization Osaka National Hospital, Osaka, Japan (Y.S.).
  • Ikehara H; Nihon University School of Medicine, Tokyo, Japan (H.I.).
  • Kinjo Y; Naha City Hospital, Naha, Japan (Y.K.).
  • Ohta T; Kansai Rosai Hospital, Amagasaki, Japan (T.O.).
  • Kitamura Y; Nara City Hospital, Nara, Japan (Y.K.).
  • Shono T; Kumamoto University, Kumamoto, Japan (T.S.).
  • Inoue T; Osaka General Medical Center, Osaka, Japan (T.I.).
  • Ohda Y; Hyogo College of Medicine, Nishinomiya, Japan (Y.O.).
  • Kobayashi N; Tochigi Cancer Center, Utsunomiya, Japan (N.K.).
  • Tanuma T; Teine Keijinkai Hospital, Sapporo, Japan (T.T.).
  • Sato R; Sapporo Higashi Tokushukai Hospital, Sapporo, Japan (R.S.).
  • Sakamoto T; National Cancer Center Hospital, Tokyo, Japan (T.S.).
  • Harada N; National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (N.H.).
  • Chino A; Cancer Institute Hospital, Tokyo, Japan (A.C.).
  • Ishikawa H; Kyoto Prefectural University of Medicine, Osaka, Japan (H.I.).
  • Nojima M; The University of Tokyo, Tokyo, Japan (M.N.).
  • Uraoka T; National Hospital Organization Tokyo Medical Center, Tokyo, Japan (T.U.).
Ann Intern Med ; 171(4): 229-237, 2019 08 20.
Article em En | MEDLINE | ID: mdl-31307055
Background: Management of anticoagulants for patients undergoing polypectomy is still controversial. Cold snare polypectomy (CSP) is reported to cause less bleeding than hot snare polypectomy (HSP). Objective: To compare outcomes between continuous administration of anticoagulants (CA) with CSP (CA+CSP) and periprocedural heparin bridging (HB) with HSP (HB+HSP) for subcentimeter colorectal polyps. Design: Multicenter, parallel, noninferiority randomized controlled trial. (University Hospital Medical Information Network Clinical Trials Registry: UMIN000019355). Setting: 30 Japanese institutions. Patients: Patients receiving anticoagulant therapy (warfarin or direct oral anticoagulants) who had at least 1 nonpedunculated subcentimeter colorectal polyp. Intervention: Patients were randomly assigned to undergo HB+HSP or CA+CSP and followed up 28 days after polypectomy. Measurements: The primary end point was incidence of polypectomy-related major bleeding (based on the incidence of poorly controlled intraprocedural bleeding or postpolypectomy bleeding requiring endoscopic hemostasis). The prespecified inferiority margin was -5% (CA+CSP vs. HB+HSP). Results: A total of 184 patients were enrolled: 90 in the HB+HSP group, 92 in the CA+CSP group, and 2 who declined to participate after enrollment. The incidence of polypectomy-related major bleeding in the HB+HSP and CA+CSP groups was 12.0% (95% CI, 5.0% to 19.1%) and 4.7% (CI, 0.2% to 9.2%), respectively. The intergroup difference for the primary end point was +7.3% (CI, -1.0% to 15.7%), with a 0.4% lower limit of 2-sided 90% CI, demonstrating the noninferiority of CA+CSP. The mean procedure time for each polyp and the hospitalization period were longer in the HB+HSP than in the CA+CSP group. Limitation: An open-label trial assessing 2 factors (anticoagulation approach and polypectomy procedure type) simultaneously. Conclusion: Patients having CA+CSP for subcentimeter colorectal polyps who were receiving oral anticoagulants did not have an increased incidence of polypectomy-related major bleeding, and procedure time and hospitalization were shorter than in those having HB+HSP. Primary Funding Source: Japanese Gastroenterological Association.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Heparina / Pólipos do Colo / Hemorragia Pós-Operatória / Eletrocoagulação / Anticoagulantes Tipo de estudo: Clinical_trials / Incidence_studies / Prognostic_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: Asia Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Heparina / Pólipos do Colo / Hemorragia Pós-Operatória / Eletrocoagulação / Anticoagulantes Tipo de estudo: Clinical_trials / Incidence_studies / Prognostic_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: Asia Idioma: En Ano de publicação: 2019 Tipo de documento: Article