Title : Unveiling the impact of anticoagulant and antiplatelet medication on hysteroscopy and polypectomy outcomes in postmenopausal bleeding patients
Abstract:
Introduction: In this retrospective study, we focused on postmenopausal bleeding patients taking anticoagulants and antiplatelet therapy during hysteroscopic polypectomies. We looked at the advice given to patients before their appointments with the aim to generate separate pathway for these patients and investigate if medications need discontinued prior to these procedures. The goal was to ensure patient safety and minimize the risk of bleeding complications and to provide standard care to all these patients. We also assessed the uniformity of medication management and identified areas for improvement.
Methodology: We conducted our study at NHS Ayrshire and Arran, focusing on Patients attending postmenopausal bleeding clinics undergoing hysteroscopic polypectomies, using Bigatti devices in outpatient settings and hysteroscopic polypectomies under general anesthesia. We collected patient data from January to December 2023 using TRAK and the Clinical portal. Details included age, type of anticoagulant/antiplatelet agents, complications and advice given was collected.
Result: In the outpatient PMB clinics: - Out of 1670 patients, 6.3% (106 patients) were on anticoagulant or antiplatelet medication. Among them, 63.2% (67 patients) had hysteroscopy, 10.4% (11 patients) had polypectomy, and 2 (18.18%) had post-polypectomy bleeding. 12.3% (13 patients) taking the above medications were referred for further operative procedures.
For outpatient Bigatti: - Out of 54 patients, 7.4% (4 patients) were on anticoagulant or antiplatelet medications- 2 on antiplatelet medications and 2 on DOACs (Edoxaban and Apixaban) -only 1 patient (25%) on Apixaban was advised to stop the medications. All 4 patients had polypectomy without immediate complications or late complications.
Polypectomies under general anesthesia: - Out of 170 patients, 5.9% (10 patients) were on anticoagulant or antiplatelet medications - 8 were on clopidogrel (75mg) and 2 on Apixaban. Only 5 of the 10 (50%) were advised (by anesthetists) to stop medications before the procedure.
Conclusion: We evaluated medication management, identified areas for improvement to generate pathways for discontinuing these medicines if needed before the procedures to provide uniformity. Our findings contribute to patient safety by minimizing bleeding risks. Clear and consistent advice to patients on these medications is crucial. Implementing the guidelines in practice will enhance care for postmenopausal bleeding patients. Further audit can assess long-term outcomes. Even though the numbers are small given that outpatient Bigatti procedure commenced in our hospital from last year and numbers are minimal at present. If we generate guidelines at this stage, we can develop standardized practice which is safe for patients. We hope our findings guide future practice and improve patient care.
