Delayed post-polypectomy bleeding following cold snare polypectomy of lesions <10 mm in patients on high-dose antithrombotic therapy: insights from a Dutch colonoscopy cohort

Abstract Current guidelines state that low-risk polypectomies (cold snare polypectomies of lesions <10 mm) can be safely performed with continuation of single antiplatelet therapy (low-dose antithrombotic therapy [ATT]). The safety of low-risk polypectomies with continuation of an anticoagulant or dual antiplatelet therapy (high-dose ATT) is uncertain. Data from 31 325 colonoscopies performed at two Dutch endoscopy centers were analyzed. The centers followed different protocols for the management of ATT around colonoscopies. Incidence of delayed post-polypectomy bleeding (DPPB) and thromboembolic events with continuation or discontinuation of different ATTs around colonoscopy were analyzed. The overall incidence of DPPB for colonoscopies with only low-risk polypectomies was 11/12 291 (0.09%). The incidence of DPPB was similar for patients continuing either high- or low-dose ATT (0.58% vs. 0.30%; P = 0.61). Although the incidence of DPPB significantly differed between patients on continued high-dose and no ATT (0.58% vs. 0.07%; P = 0.04), the absolute risk difference was small (0.67%) and the number of patients required to discontinue high-dose ATT to prevent one case of DPPB was estimated at 150. The severity of DPPBs was comparable between all groups. The incidence of thromboembolic events with ATT discontinuation was 2/1098 (0.18%). The risk of DPPB after low-risk polypectomies was similar for patients who continued high- and low-dose ATT. Although higher compared with patients without ATT, the incidence of DPPB with continued high-dose ATT remains very low. Therefore, we suggest continuation of high-dose ATT for colonoscopy indications with a low risk of detecting advanced polyps.