CLINICAL RESEARCH
Antithrombotic/antiplatelet therapy and colonoscopy results in patients over 50 with iron-deficiency anemia
 
More details
Hide details
1
Department of Gastrointestinal Surgery, Kartal Kosuyolu High Speciality and Training Hospital, Istanbul, Turkey
 
 
Submission date: 2019-05-14
 
 
Acceptance date: 2019-06-12
 
 
Publication date: 2019-07-18
 
 
Arch Med Sci Civil Dis 2019;4(1):28-33
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
This study aims to evaluate the results of asymptomatic patients who have been using anticoagulant-antiaggregant (AC-AA) agents and have had colonoscopy screening due to iron-deficiency anemia (IDA).

Material and methods:
The data of 347 asymptomatic patients over the age of 50, who have received colonoscopy due to IDA, were reviewed retrospectively. The effects of sex and AC-AA administration on positive colonoscopy results, preneoplastic lesions and malignancy were investigated.

Results:
Of 347 patients over 50 with IDA, 204 were female (58.8%). The mean age was 63.4 ±8.4. Positive colonoscopy results were observed more commonly in 69 male patients compared to 67 female patients (p = 0.004). Similarly, positive colonoscopy results were found to be more frequent among patients using AC-AA (p = 0.019). While premalignant lesions were more frequently diagnosed in male patients (23% to 10.2%), the results were also statistically significant (p = 0.002). Anticoagulant administration did not contribute to the increase in preneoplastic lesion rates (15.57% to 15.55%). Malignant pathology, which was seen in 8 male patients, was more common among male patients yet it was not statistically significant (p = 0.081). However, compared to 3 patients who did not use AC-AA, malignant pathology was seen more frequently in 9 patients who were on AC-AA and the figure was statistically significant (p = 0.009).

Conclusions:
The AC-AA administration in asymptomatic patients over 50 with IDA who have had colonoscopy screening increases the rate of colorectal malignancy diagnosis, while it leads to no change in the rate of preneoplastic lesion detection. Nevertheless, male sex is a factor that increases the possibility of preneoplastic lesion detection.

 
REFERENCES (33)
1.
Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 in the United States: evidence for a high rate of unexplainedanemia. Blood 2004; 104: 2263-8.
 
2.
World Health Organization. Iron Deficiency Anaemia Assessment, Prevention and Control: A Guide for Programme Managers. Geneva: World Health Organization 2001.
 
3.
Chandyo RK, Henjum S, Ulak M, et al. The prevalence of anemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal. Eur J Clin Nutr 2016; 70: 456-62.
 
4.
Abu-Ouf NM, Jan MM. The impact of maternal iron deficiency and iron deficiency anemia on child’shealth. Saudi Med J 2015; 36: 146-9.
 
5.
Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet 2016; 387: 907-16.
 
6.
Andrews P. A. Disorders of iron metabolism. N Engl J Med 2000; 342: 1293-4.
 
7.
McIntyre AS, Long RG. Prospective survey of investigations in outpatients referred with iron deficiency anemia. Gut 1993; 34: 1102-7.
 
8.
Goodman D, Irvin TT. Delay in the diagnosis and prognosis of carcinoma of the right colon. Br J Surg 1993; 80: 1327-9.
 
9.
Antman EM, Wiviott SD, Murphy SA, et al. Early and late benefits of prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a TRITON-TIMI (Trial to Assess Improvement in Therapeutic Outcomesby Optimizing Platelet InhibitioN with Prasugrel-Thrombolysis In Myocardial Infarction) analysis. J Am Coll Cardiol 2008; 51: 2028-33.
 
10.
Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revisethe 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007; 50: e1-157.
 
11.
Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. BMJ 2004; 329: 15-9.
 
12.
Rutter CM, Johnson E, Miglioretti DL, Mandelson MT, Inadomi J, Buist DS. Adverse events after screening and follow up colonoscopy. Cancer Causes Control 2012; 23: 289-96.
 
13.
Fox JP, Burkardt DD, Ranasinghe I, Gross CP. Hospital-based acute care after outpatient colonoscopy: implications for quality measurement in the ambulatory setting. Med Care 2014; 52: 801-8.
 
14.
Tran AH, Man Ngor EW, Wu BU. Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA Intern Med 2014; 174: 1675-82.
 
15.
Hawn MT, Graham LA, Richman JS, Itani KM, Henderson WG, Maddox TM. Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents. JAMA 2013; 310: 1462-72.
 
16.
Acosta RD, Abraham NS, Chandrasekhara V, et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc 2016; 83: 3-16.
 
17.
Becker RC, Scheiman J, Dauerman HL, et al. Management of platelet-directed pharmacotherapy in patients with atherosclerotic coronary artery disease undergoing elective endoscopic gastrointestinal procedures. Am J Gastroenterol 2009; 104: 2903-17.
 
18.
Veitch AM, Vanbiervliet G, Gershlick AH, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Gut 2016; 65: 374-89.
 
19.
Camaschella C. Iron-deficiency anemia. N Eng J Med 2015; 372: 1832-43.
 
20.
Vucelic D, Nenadic B, Pesko P, et al. Iron deficiency anemia and its importance in gastroenterology clinical practise. Acta Chirur Iugoslav 2007; 54: 91-105.
 
21.
Cook JD, Skikne BS: iron deficiency: definition and diagnosis. J Intern Med 1989; 226: 349-55.
 
22.
Kepczyk T, Kadakia SC. Prospective evaluation of gastrointestinal tract in patients with iron-deficiency anemia. Dig Dis Sci 1995; 40: 1283-9.
 
23.
Rockey DC, Cello JP. Evaluation of the gastro-intestinal tract in patients with iron-deficiency anemia. N Engl J Med 1993; 329: 1691-5.
 
24.
Cook IJ, Pavli P, Riley JW, Goulston KJ, Dent OF. Gastrointestinal investigation of iron deficiency anaemia. BMJ 1986; 292: 1380-2.
 
25.
Hardwick RH, Armstrong CP. Synchronous upper and lower gastrointestinal endoscopy is an effective method of investigating iron-deficiency anaemia. Br J Surg 1997; 84: 1725-8.
 
26.
James MW, Chen CM, Goddard WP, Scott BB, Goddard AF. Risk factors for gastrointestinal malignancy in patients with iron-deficiency anaemia. Eur J Gastroenterol Hepatol 2005; 17: 1197-203.
 
27.
Cairns SR, Scolefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening in high risk groups (update from 2002). Gut 2010; 59: 666e90.
 
28.
Boparai KS, Mathus-Vliegen EM, Koornstra JJ, et al. Increased colorectal cancer risk during follow-up in patients with hyperplastic polyposis syndrome: a multicenter cohort study. Gut 2010; 59: 1098-100.
 
29.
NCCN Clinical Guidelines in Oncolgy. Colorectal Cancer screening, 2013.
 
30.
Kishida T, Shinozawa I, Tanaka S, Hoshino T. Significance of serum iron and ferritin in patients with colorectal adenomas. Scand J Gastroenterol 1997; 32: 233-7.
 
31.
Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328: 1365-71.
 
32.
Zuckerman GR, Prakash C, Askin MP, Lewis BS. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000; 118: 201-21.
 
33.
Johnson DA, Lieberman D, Inadomi JM, Ladabaum U, Becker RC, Gross SA. Increased post-procedural non-gastrointestinal adverse events after outpatient colonoscopy in high-risk patients. Clin Gastroenterol Hepatol 2017; 15: 883-91.
 
ISSN:2451-0637
Journals System - logo
Scroll to top