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

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. Methods 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. Results 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%). Conclusion 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.