Safety of Cold Snare Polypectomy in Patients Receiving Treatment with Antithrombotic Agents
- 24 Downloads
With the aging of the population and rising incidence of thromboembolic events, the clinical use of antithrombotic agents is also increasing. There are few reports yet on the management of antithrombotic agent use in patients undergoing cold snare polypectomy (CSP).
The aim of this study was to evaluate whether continued administration of antithrombotic agents in patients undergoing CSP would be associated with an increased rate of delayed post-polypectomy bleeding (DPPB).
A total of 1177 colorectal polyps in 501 patients were resected at Omori Red Cross Hospital between October 2017 and March 2018. The polyps were divided into two groups depending on whether the patients received antithrombotic agent treatment or not: the antithrombotic group (911 polyps) and the no-antithrombotic group (266 polyps).
Among the 1177 polyp resections, there was no case of DPPB, including in the antithrombotic group. Immediate bleeding occurred in a total of 63 (5.4%) cases. Polyp location in the rectum (OR (95% CI) 2.64 (1.223–5.679); p = 0.013), polyp size ≥ 6 mm (OR (95% CI) 4.64 (2.719–7.933); p < 0.001), polypoid growth pattern (OR (95% CI) 2.78 (1.607–4.793); p < 0.001), and antithrombotic agent use (OR (95% CI) 2.98 (1.715–5.183); p < 0.001) were identified as significant risk factors of immediate bleeding.
Continued use of antithrombotic agents does not increase the risk of DPPB, even in those receiving multiple antithrombotic agents. Thus, it is safe to perform CSP even in multiple agent users. Prospective, randomized studies are necessary to confirm our results.
KeywordsColorectal polyps Cold snare polypectomy Antithrombotic agent Delayed bleeding post-polypectomy
Endoscopic mucosal resection
Delayed post-polypectomy bleeding
Cold snare polypectomy
Direct oral anticoagulants
- 95% CI
95% Confidence interval
The authors would like to thank the staff of the participating institutions for their support in recruiting eligible patients, and also the patients who participated in this study.
JA, HC, SK, TG, and AN conceived of the study. JA, KA, HA, JT, TS, NK, TN, HK, MN, TI, and TM performed the CSP. JA and RF recruited the study participants. Analysis and interpretation of the data were conducted by JA and HC. All the authors have read the final manuscript and approve of its submission for publication.
Compliance with ethical standards
Conflicts of interest
No support from any organization was received for the submitted work; there were no financial relationships with any organizations that might have had an interest in the submitted work in the previous 3 years, and there are no other relationships or activities to declare that could have potentially influenced the outcomes of the submitted work. The authors have no conflicts of interests to disclose.
- 39.Chiba H, Ohata K, Tachikawa J, et al. Delayed bleeding after colorectal endoscopic submucosal dissection: When is emergency colonoscopy needed? Dig Dis Sci. 2018. https://doi.org/10.1007/s10620-018-5310-2.