Delayed Bleeding Following Cold Snare Polypectomy for Small Colorectal Polyps in Patients Taking Antithrombotic Agents

Makino, Toshiyuki; Horiuchi, Akira; Kajiyama, Masashi; Tanaka, Naoki; Sakai, Kenji; Maetani, Iruru

doi:10.1097/mcg.0000000000000802

Cited by 40 publications

(43 citation statements)

References 16 publications

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“…The use of antithrombotics was identified as a significant risk factor for immediate bleeding, which occurred in 63 (5.4%) cases and was readily controlled without any significant clinical consequences. The finding of no cases of DPPB is compatible with several available studies of patients taking antithrombotics without discontinuation prior to polypectomy (Table 1), with rates of DPPB ranging from 0 to 1.2% [4,9,10], lending support to the safety of CSP.…”

supporting

confidence: 85%

Some Like It Cold: Postpolypectomy Delayed Hemorrhage in Anticoagulated Patients

Hsieh

Koo

2019

Dig Dis Sci

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supporting

confidence: 85%

Some Like It Cold: Postpolypectomy Delayed Hemorrhage in Anticoagulated Patients

Hsieh

Koo

2019

Dig Dis Sci

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“…In regard to antiplatelet drugs, some recent studies have shown that continuation of clopidogrel was a low-risk factor in CP [15-17]. In our study, there was only one patient taking clopidogrel and no bleeding occurred in that patient.…”

Section: Discussionmentioning

confidence: 54%

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

et al. 2018

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Background: The cold polypectomy (CP) technique has been increasingly used in recent years. However, there have been few studies about post-polypectomy bleeding (PPB) in patients who underwent CP and who were on antithrombotic drugs. The objective of this study was to determine the safety of CP in patients on antithrombotic medication. Methods: The subjects were patients who underwent CP in our hospital between April 2014 and March 2016. PPB rates were examined in relation to the use of antithrombotic medication. Results: CP was performed to remove 2,466 polyps in 1,003 patients. There were 549 polyps (22.3%) in186 patients in the antithrombotic group and 1,917 polyps (77.7%) in 817 patients in the non-antithrombotic group. PPB occurred in 0.55% (3/549) of patients in the antithrombotic group and in 0.10% (2/1,917) of patients in the non-antithrombotic group, showing no significant difference (p = 0.07). Patients in the antithrombotic group in whom PPB occurred included 1 aspirin user with 1 polyp and 1 aspirin plus clopidogrel user with 2 polyps. No PPB occurred in patients on other antithrombotic agents or receiving heparin bridging. There was no significant difference between PPB rates in patients with small polyps (6–9 mm) in the antithrombotic and non-antithrombotic groups, but there was a significant difference between PPB rates in the 2 groups for patients with diminutive group (1–5 mm). Conclusion: CP is a safe procedure even in patients on antithrombotic medication.

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“…5 Two studies have specifically looked at CSP on antithrombotics. 22,23 Overall, the risk of delayed postpolypectomy bleeding following CSP was acceptably low, with only 2 of 207 patients on therapeutic antithrombotic agents experiencing delayed postpolypectomy bleeding. Both of these patients were on direct oral anticoagulants (dabigatran and apixaban).…”

Section: Discussionmentioning

confidence: 99%

“…Both of these patients were on direct oral anticoagulants (dabigatran and apixaban). 22,23 Complete resection is now considered a powerful indicator of the quality of colonoscopy. 24 HSP has conventionally been used, which is thought to provide thermal ablation of polyp at the polypectomy margin.…”

Section: Discussionmentioning

confidence: 99%

Complications of cold versus hot snare polypectomy of 10–20 mm polyps: A retrospective cohort study

Ket

Mangira

et al. 2019

JGH Open

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Background and Aim Cold snare polypectomy is safe and efficacious for removing polyps <10 mm with reduced rates of delayed postpolypectomy bleeding and postpolypectomy syndrome. This technique can also be used for sessile polyps ≥10 mm; however, further evidence is required to establish its safety. The aim of this study was to compare intraprocedure and postprocedure adverse events in patients who underwent cold (CSP) versus hot snare polypectomy (HSP) of 10–20 mm sessile colonic polyps. Methods Electronic medical records and endoscopy reports of all patients who underwent polypectomy for Paris 0‐IIa, Is, or 0‐IIa + Is 10–20 mm colonic polyps between January 2015 and June 2017 at three tertiary academic hospitals and one private hospital were retrospectively reviewed. Data on patient demographics, polyp characteristics, method of polypectomy, and intraprocedural and postpolypectomy adverse events were collected. Results A total of 408 patients (median age 67, 50% male) had 604 polyps, 10–20 mm in size, removed. Of these, 258 polyps were removed by HSP, with a median size of 15 mm (interquartile range [IQR] 12–20), compared to 346 polyps that were removed by CSP, with median size of 12 mm (IQR 10–15), P < 0.001. In the HSP group, 15 patients presented with postprocedure complications, including 11 with clinically significant bleeding, 2 with postpolypectomy syndrome, and 2 with abdominal pain. This compares with no postpolypectomy complications in the CSP group, P < 0.001. Conclusion In this study, CSP was not associated with any postpolypectomy adverse events. CSP appears to be safer than HSP for removing 10–20 mm‐sized sessile polyps. A prospective multicenter study has been commenced to verify these findings and to assess the efficacy of CSP for the complete resection of polyps of this size.

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Delayed Bleeding Following Cold Snare Polypectomy for Small Colorectal Polyps in Patients Taking Antithrombotic Agents

Abstract: Colorectal polyps ≤10 mm can be removed without an increase in delayed bleeding using dedicated cold snare polypectomy in patients taking antithrombotic agents.

Cited by 40 publications

References 16 publications

Some Like It Cold: Postpolypectomy Delayed Hemorrhage in Anticoagulated Patients

Some Like It Cold: Postpolypectomy Delayed Hemorrhage in Anticoagulated Patients

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

Complications of cold versus hot snare polypectomy of 10–20 mm polyps: A retrospective cohort study

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