Management of Anticoagulant and Antiplatelet Agents in Acute Gastrointestinal Bleeding and Prevention of Gastrointestinal Bleeding

Managing gastrointestinal bleeding in patients using antithrombotic agents remains challenging in clinical practice. This review article provides a comprehensive and evidence-based approach to managing acute antithrombotic-related gastrointestinal bleeding, focusing on the triage of patients, appropriate resuscitation, and timely endoscopy. The latest clinical practice guidelines are highlighted to guide decisions concerning the use of reversal agents, temporary interruption, and resumption of antithrombotic drugs. Additionally, preventive measures are discussed to lower the risk of future bleeding and minimize complications among patients prescribed antithrombotic drugs.

Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon

Post-polypectomy bleeding (PPB) remains a significant procedure-related complication, with multiple risk factors determining the risk including patient demographics, polyp characteristics, endoscopist expertise, and techniques of polypectomy. Immediate PPB is usually treated promptly, but management of delayed PPB can be challenging. Cold snare polypectomy is the optimal technique for small sessile polyps with hot snare polypectomy for pedunculated and large sessile polyps. Topical hemostatic powders and gels are being investigated for the prevention and management of PPB. Further studies are needed to compare these topical agents with conventional therapy.

Combined endoloop and endoclip application for prevention of postpolypectomy bleeding

AIM: To evaluate the value of combined endoloop and hemoclip application as a prophylactic method for postpolypectomy bleeding in patients with large (≥2 cm) pedunculated colonic polyps.

METHODS: Patients with pedunculated colonic polyps (≥2 cm) were included in this study retrospectively and divided into a control group and an experimental group. In the control group, endoclips were used after conventional polypectomy. In the experimental group, an endoloop was placed at the base of the stalk followed by conventional polypectomy and clip application in the residual stalk above the snare. The efficacy in preventing early and late postpolypectomy bleeding, rate of severe bleeding, and days of hospitalization were evaluated.

RESULTS: Overall, bleeding complications occurred in 5/72 polyps (6.94%). In the control group (endoclips alone), 4/42 (9.52%) had a bleeding episode: three (7.14%) occurred during the first 24 h and one (2.3%) between days 1 and 30 from the procedure. In the experimental group only 1 of 32 polyps (3.12%) had a late bleeding episode (P = 0.275). Severity of late bleeding in the experimental group (one case of moderate bleeding) vs the control group (3 cases of moderate and one case of severe bleeding) and need for transfusions (0 vs 2 blood units) were lower. Colonoscopy time was significantly higher in the experimental group vs the control group (P = 0.027), but hospitalization days were shorter in the experimental group (P = 0.047).

CONCLUSION: Endoloop combined with endoclip technique seems to be more effective than endoclip alone in preventing postpolypectomy bleeding in large pedunculated colonic polyps.