Temporary interruption versus continuation of non-aspirin, non-P2Y12 antiplatelet monotherapy for delayed post-polypectomy bleeding

Background/Study aim: The Japan Gastrointestinal Endoscopy Society guidelines indicate that antiplatelet agents (APAs) other than aspirin and P2Y12 receptor antagonists (other APAs) may be interrupted the day before high-bleeding-risk procedures. However, this recommendation is based on low-quality evidence, and no comparative data exist. We aimed to evaluate whether 1-day interruption of other APAs reduced delayed post-polypectomy bleeding (DPPB) in patients undergoing hot snare polypectomy (HSP) or endoscopic mucosal resection (EMR). Patient and methods: This retrospective multicenter cohort study included consecutive patients who received monotherapy with other APAs and underwent colorectal HSP/EMR between April 2020 and March 2024. The patients were categorized into the interruption and continuation groups. We compared the patient backgrounds, polyp findings, use of prophylactic clipping, intraprocedural bleeding, and DPPB between the two groups. Propensity score matching (PSM) was performed to reduce confounding factors. Results: In total, 506 patients received monotherapy with other APAs, and 192 matched pairs were evaluated. The baseline and procedural characteristics were well balanced after PSM. DPPB occurred in 2 patients (1.0%) in both the interruption and continuation groups (p = 1; absolute risk difference, 0.0% [95% confidence interval: -2.0 to 2.0]). Thromboembolic events occurred in 1 and 0 patients in the interruption and continuation groups, respectively. Conclusions: One-day interruption of other APAs was not associated with a clear reduction in DPPB risk during HSP/EMR. Given the risk of thromboembolism after interruption, routine discontinuation may be unnecessary. Prospective studies are needed to reassess the current guideline recommendations.