Continuing Clopidogrel Increases Intraprocedural Bleeding and Clip Use After Cold Snare Polypectomy, but Not Delayed Bleeding

Guidelines have often recommended the continuation of clopidogrel for diagnostic colonoscopy but discontinuation for polypectomy, which is impractical because polypectomy rates are so high during diagnostic colonoscopy.

The current study included patients who were already receiving clopidogrel alone (n=66) or dual therapy with clopidogrel plus aspirin (n=41) and randomized them to either continue clopidogrel alone or discontinue clopidogrel but continue or substitute aspirin for 7 days before and 2 days after colonoscopy. All polyps were removed by cold snare polypectomy and were ≤10 mm. Of the removed polyps, 134 were removed in the clopidogrel-continuation arm versus 142 in the aspirin-only arm. According to the results, 86% of all patients included in the study had a polyp removed, with a median of 2 polyps removed per patient.

Clip use was recommended in the trial if intraprocedural bleeding persisted for more than 2 minutes. Intraprocedural bleeding requiring clips occurred in 11 of 49 clopidogrel-continuation patients and 2 of 43 taking aspirin alone (P=.02). Minor postprocedural bleeding was seen in the aspirin-only group more often than in the clopidogrel-continuation group (6/43 vs 1/49; P=.03). One nonfatal cardiac ischemic event occurred in each arm.

The trial was stopped early because of inadequate patient accrual.