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

Background 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. <b>Methods</b> Data from 31,325 colonoscopies performed at two Dutch endoscopy centers were analyzed. The included centers followed different protocols for the management of ATT around colonoscopies. Incidence rates of delayed post-polypectomy bleedings (DPPBs) and thromboembolic events (TEs) in patients who either continued or discontinued different types of ATT around colonoscopy were analyzed. <b>Results</b> Overall incidence of DPPBs for colonoscopies with only low-risk polypectomies was 11/12,291 (0.09%). The incidence of DPPBs was similar for patients on continued high- and low-dose ATT (0.58% vs. 0.30%, p=0.61). Although the incidence of DPPBs 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 requiring discontinuation of 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 TEs with ATT discontinuation was 2/1,098 (0.18%). <b>Conclusion</b> The risk of DPPB after low-risk polypectomies is similar for patients who continue high- and low-dose ATT. Although higher compared to patients without ATT, the incidence of DPPBs 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.

Publikationsverlauf

Eingereicht: 20. April 2025

Angenommen nach Revision: 08. Oktober 2025

Accepted Manuscript online:
10. Oktober 2025