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Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ENDOSCOPY

Relationship of INR Levels to Rates of Post-Polypectomy Bleeding


Ruff, Kevin C. M.D.; Harewood, Gavin C. M.D.; Pardi, Darrell S. M.D.

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American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S368-S369
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Purpose: To determine whether there is an increased risk of post-polypectomy bleeding in the setting of elevated INR levels, and at what INR level this risk increases. This information will facilitate evidence based guidelines for polypectomies in patients with coagulopathy.

Methods: A retrospective review using the institutional database of all colonoscopies performed from 01/01/04 through 06/30/04 was used to identify all colonic polypectomies over this period. This list was cross-referenced with the laboratory database to identify those procedures for which both platelet and INR levels were available within one month of the procedure performance. Analysis was confined to those patients in whom platelet levels were >100,000. The medical records related to these procedures were reviewed to identify post-procedure bleeding. Post-polypectomy bleeding was characterized by hematochezia within 1 week of the procedure.

Results: 464 polypectomies performed in 437 patients meeting the above criteria were identified. Bleeding rates according to varying INR levels are illustrated in figure 1. For INR <=1.3 no significant differences in bleeding rate were identified; for INR >=1.4 bleeding rates increased (10.7% for INR <=1.4 vs. 20.8% for INR>1.4).[figure 1]


Conclusions: An INR level of 1.3 appears to be the upper limit for safe performance of colonic polypectomy.

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