Cold-snare polypectomy of colorectal lesions less than 10 mm in size can be safely done, if direct-acting oral anticoagulants (DOAC) are stopped only on the day of the procedure, suggests a new study from Japan reported in the journal Gastrointestinal Endoscopy.¹

Horiuchi et al enrolled patients with colorectal polyps ≤10 mm in diameter who were scheduled for cold snare polypectomy in their study with the objective to compare the effects of continuing DOAC on the day of procedure against stopping them only on the day of the procedure.

For this, they divided the patients into two groups based on the time period. During period 1 (2017 and 2018), patients continued with the DOAC (DOAC continued group; n = 204) when they underwent cold snare polypectomy, while in period 2 (2019 and 2020), DOACs were stopped only on the day of the procedure (DOAC withheld group; n = 264) and started again the next day following the procedure.

The primary end point of delayed bleeding within 2 weeks of the procedure requiring endoscopic treatment occurred in four out of the 47 patients (8.5%) who continued with the DOAC vis a vis none (0/66) in the group which discontinued the DOAC on the day of the procedure.

Immediate bleeding (after 30 seconds) after the polypectomy occurred in 12 of the 47 patients who continued DOAC (secondary outcome measure) compared to only four out of 66 patients (6.1%) in whom the anticoagulants were stopped on the day of the procedure. Clips to prevent/control the bleeding were used in nearly 32% of those who continued with the DOAC even on the day of the procedure versus 9.1% in the DOAC withheld group.

It is generally recommended to stop the oral anticoagulation at least ≥48 hours before the procedure and is recommenced up to 1 to 2 days after the procedure once adequate hemostasis is achieved.

This study has demonstrated the safety of discontinuing DOAC only on the day of the procedure in patients undergoing cold snare polypectomy for colorectal lesions less than 10 mm in preventing delayed bleeding. Based on their findings, the study authors recommend the strategy of “withholding of DOACs in cold snare polypectomy for colorectal polyps (10 mm or less) . . . only on the day of the procedure.”

Reference

1. Morita A, et al. Managing bleeding risk following cold snare polypectomy in patients receiving direct-acting oral anticoagulants. Gastrointest Endosc. 2022 Jan 19;S0016-5107(22)00040-2. doi: 10.1016/j.gie.2022.01.005.