International Session(Workshop)3(JGES・JSGE・JSGS・JSGCS)
Sat. November 4th   14:00 - 16:30   Room 11: Portopia Hotel South Wing Topaz
Continuous Warfarin administration versus Heparin bridging therapy in post colorectal polypectomy haemorrhage (WHICH study)
Shigetsugu Tsuji1, Yasuaki Nagami2, Takayuki Katsuno3
1Department of Gastroenterology, Ishikawa Prefectural Central Hospital, 2Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 3Department of Gastroenterology, Izumiotsu Municipal Hospital
Aims; While heparin bridge (HB) has been a standard strategy for colorectal polypectomy in patients taking warfarin, continuous warfarin administration (CWA) was expected not to increase post-polypectomy bleeding (PPB) without hospitalization. We conducted a prospective multicenter randomized controlled non-inferiority trial comparing PPB between CWA and HB.
Methods; Patients taking warfarin who would undergo colorectal polypectomy were enrolled. Enrolled patients were assigned to the CWA and HB groups in a 1 to 1 ratio and underwent polypectomy using electrocautery. The primary outcome measure was the PPB rate.
Results; A total of 325 patients were enrolled and 316 underwent randomized. After each 7 patient was excluded, 151 in each group were analysed. PPB occurred in 7.9% in CWA and 23.6% in the HB group, respectively. The intergroup difference for the primary outcome was -15.7% (95%CI; -24.0% to -7.7%), which was lower than the pre-set non-inferiority margin of 5% (p<0.001). Hospitalization period was 3 days in CWA and 13 days in the HB group (p<0.001).
Conclusions; In patients taking warfarin, CWA did not increase PPB with shorter hospitalization, compared to HB.
Index Term 1: polypectomy
Index Term 2: anticoagulant
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