"No delayed bleeding in colonoscopy with cold snare polypectomy occurred in patients withholding DOACs on the day of cold snare polypectomy," researchers write in Gastrointestinal Endoscopy. "The simplified strategy that withholding of DOACs in cold snare polypectomy for colorectal polyps (10 mm or less) . . . only on the day of the procedure can be recommended."
Dr. Akira Horiuchi of Showa Inan General Hospital in Komagane and his colleagues compared how continuing vs. stopping DOACs on only the day of a cold-snare polypectomy procedure affected bleeding.
In a prospective, observational cohort study done at one test site, the researchers enrolled consecutive patients receiving antithrombotic agents undergoing cold-snare polypectomy of colorectal polyps 10 mm or less in diameter.
Participants were divided into two groups based on time period. For patients in the first two-year period, antithrombotic agents including DOACs were not discontinued. For patients in the second two-year period, DOACs were withheld only on the day of the procedure and were restarted the day after the procedure.
Patients in both groups were in the mid-seventies on average. The clinical features were similar between the 204 who took continuous DOACs and the 264 who discontinued DOACs on the day of the procedure.
Delayed bleeding within two weeks following cold-snare polypectomy occurred in four of the 47 patients who continued taking DOACs compared with none among the 66 patients who did not take DOACs on the day of the procedure (P<0.001).
Immediate postpolypectomy bleeding was found in 12 of the 47 patients who were given DOACs on the day of the procedure versus four who were not given DOACs on that day (P<0.008).
"Current practice guidelines in the United States recommend the discontinuation of DOACs before polypectomy including cold snare polypectomy and only reinitiating DOACSs after adequate hemostasis is ensured. The best strategy to manage direct-acting oral anticoagulants for patients undergoing cold snare polypectomy remains unclear," the authors write. "Cold snare polypectomy may be safely preformed if direct-acting oral anticoagulants are withheld only on the day of the procedure."
No commercial funding or conflicts of interest were reported.
Dr. Horiuchi was not able to respond to requests for comment by press time.
SOURCE: https://bit.ly/34q79oD Gastrointestinal Endoscopy, online January 18, 2022.
By Reuters Staff
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