Safety of Cold Snare Polypectomy in Patients Receiving Treatment with Antithrombotic Agents

  • Jun Arimoto
  • Hideyuki ChibaEmail author
  • Keiichi Ashikari
  • Ryo Fukui
  • Hideyuki Anan
  • Jun Tachikawa
  • Takuma Suto
  • Naoya Kawano
  • Toshihiro Niikura
  • Hiroki Kuwabara
  • Michiko Nakaoka
  • Shingo Kato
  • Tomonori Ida
  • Taiki Morohashi
  • Tohru Goto
  • Atsushi Nakajima
Original Article



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.


Colorectal polyps Cold snare polypectomy Antithrombotic agent Delayed bleeding post-polypectomy 



Colorectal cancer


Hot polypectomy


Endoscopic mucosal resection


Delayed post-polypectomy bleeding


Cold snare polypectomy


Direct oral anticoagulants


Polyethylene glycol


Standard deviation


Odds ratio

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.

Author's contribution

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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jun Arimoto
    • 1
  • Hideyuki Chiba
    • 1
    Email author
  • Keiichi Ashikari
    • 2
  • Ryo Fukui
    • 1
  • Hideyuki Anan
    • 1
  • Jun Tachikawa
    • 1
  • Takuma Suto
    • 1
  • Naoya Kawano
    • 1
  • Toshihiro Niikura
    • 1
  • Hiroki Kuwabara
    • 1
  • Michiko Nakaoka
    • 1
  • Shingo Kato
    • 2
  • Tomonori Ida
    • 1
  • Taiki Morohashi
    • 1
  • Tohru Goto
    • 1
  • Atsushi Nakajima
    • 2
  1. 1.Department of GastroenterologyOmori Red Cross HospitalTokyoJapan
  2. 2.Department of Gastroenterology and HepatologyYokohama City University School of MedicineYokohamaJapan

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