Minimum Platelet Count Threshold for Safe Colonoscopic Polypectomy: A Large-Scale Propensity Scored-Matched Analysis

Abstract

INTRODUCTION: The association between postpolypectomy 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-related, polyp-related, and procedure-related factors, were collected. We identified the optimal platelet cutoff value of 90,000/mu L using the Youden Index method and conducted propensity score matching and inverse probability of treatment weighting 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/mu L, and 16,654 (98.8%) had platelet counts >= 90,000/mu L. After propensity score matching, patients with platelet counts <90,000/mu L demonstrated significantly elevated risks of immediate PPB (odds ratio 2.67, 95% confidence interval 1.06-6.71) and delayed PPB (odds ratio 9.66, 95% confidence interval 1.21-77.52) compared with those with platelet counts >= 90,000/mu L. In high-risk procedures (endoscopic mucosal resection and endoscopic submucosal dissection for large polyp >20 mm), the optimal platelet count threshold was identified as 100,000/mu L for safe colonoscopic polypectomy. The results obtained using inverse probability of treatment weighting were consistent. DISCUSSION: Patients with platelet counts <90,000/mu L exhibited significantly elevated rates of immediate PPB and delayed PPB, suggesting that maintaining platelet levels above this threshold may be crucial for ensuring the safety of colonic polypectomy.