Minimum platelet count threshold for safe colonoscopic polypectomy: A large-scale propensity scored-matched analysis.

Abstract

Introduction: The association between post-polypectomy bleeding (PPB) and thrombocytopenia remains unclear, and current evidence is insufficient to provide definitive guidelines for managing patients with thrombocytopenia undergoing endoscopic procedures. We assessed the association between thrombocytopenia and PPB to identify the minimum platelet count threshold for safe colonoscopic polypectomy.

Methods: This large cohort study included patients who had undergone colonoscopy and polypectomy in Korea between 2005 and 2022. A wide range of covariates, including patient-, polyp-, and procedure-related factors, were collected. We identified the optimal platelet cut-off value of 90,000/μL using Youden's Index method and conducted propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses to determine the effect of thrombocytopenia on PPB risk.

Results: Overall, 21,562 patients were screened, including 16,852 individuals and 41,930 polyps. Among these patients, 198 (1.2%) had platelet counts < 90,000/μL, and 16,654 (98.8%) had platelet counts of ≥ 90,000/μL. After PSM, patients with platelet counts < 90,000/μL demonstrated significantly elevated risks for immediate PPB (OR 2.67, 95% CI 1.06-6.71) and delayed PPB (OR 9.66, 95% CI 1.21-77.52) compared with those with platelet counts of ≥ 90,000/μL. In high-risk procedures (EMR and ESD for large polyp > 20 mm), the optimal platelet count threshold was identified as 100,000/μL for safe colonoscopic polypectomy. The results obtained using IPTW were consistent.

Discussion: Patients with platelet counts < 90,000/μL exhibited significantly elevated rates of IPPB and DPPB, suggesting that maintaining platelet levels above this threshold may be crucial for ensuring the safety of colonic polypectomy.