Risk of delayed bleeding after hot snare polypectomy and endoscopic mucosal resection in the colorectum with continuation of anticoagulants

Abstract

Background: Current guidelines recommend the temporary discontinuation of anticoagulants before colonoscopic polypectomy, but the effect of this practice on reducing the risk of delayed bleeding after hot snare polypectomy (HSP) and endoscopic mucosal resection (EMR) remains unclear. Our aim was to assess the impact of anticoagulants on the risk of colorectal delayed bleeding after HSP and EMR, and evaluate the necessity of drug withdrawal. Methods: We reviewed the clinical data of patients with colorectal polyps using antithrombotic drugs who underwent HSP and/or EMR between January 2016 and September 2020 at Nagaoka Red Cross Hospital. After excluding antiplatelet users, patients were classified into those who continued anticoagulants [continuation group: 50 patients (93 lesions)] and those who discontinued anticoagulants [discontinuation group: 87 patients (190 lesions)].Results: Delayed bleeding occurred in 12 lesions, and there was no significant difference in the incidence rates between the continuation and the discontinuation groups (3.2% vs. 4.7%; P=0.756). Logistic regression analysis showed that continued use of anticoagulants was not a significant risk factor for delayed bleeding compared to anticoagulant discontinuation (odds ratio, 0.670; 95% CI, 0.177-2.537; P=0.556). There was no significant difference in the incidence rate and risk of delayed bleeding, regardless of the length of the anticoagulant withdrawal period.Conclusions: Continued use of anticoagulants, compared to their discontinuation, did not increase the risk of colorectal delayed bleeding after HSP and EMR. Our results suggest that current guideline recommendations for anticoagulant withdrawal before colonoscopic polypectomy may be reconsidered.

International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy

“… 65 , 74 , 79 - 81 , 84 , 85 , 88 , 93 , 94 , 96 , 100 Some studies have advocated for continuing warfarin therapy before and after therapeutic procedures. 59 , 62 , 82 , 83 , 86 , 87 , 89 , 90 , 92 , 95 , 97 - 99 However, most of these studies were conducted in Japan, and their retrospective nature hampered changes in previous statements. 59 , 82 , 83 , 86 , 89 , 90 , 92 , 95 , 97 , 98 Considering that temporary interruption of anticoagulation therapy during procedures was associated with a significantly higher risk of thromboembolic events 53 and continuing antithrombotic therapy was associated with a significantly higher risk of procedure-related bleeding, 91 we still need to stratify the patients’ thromboembolic risk, and heparin bridging therapy is recommended for only patients with a high thromboembolic risk.…”

“…One multicenter, parallel, non-inferiority RCT 79 and 26 retrospective or prospective cohort studies 59,62,65,74, procedures, such as colorectal EMR, 59,62,74,[79][80][81][82][83][84][85][86]88,89,91,[93][94][95][96]100 ESD, 74,79,90,96 gastric ESD, 65,74,79,96,98 EST, 74,79,92 esophageal ESD, 74,79 duodenal EMR, 79 PEG, 74,99 endoscopic ultrasound-guided fine needle aspiration, 74,87 and endoscopic ultrasound-guided biliary drainage 97 were evaluated. Most studies focused on the risks and benefits of heparin bridging therapy before the procedure.…”