The Risk of Colonoscopy‐related Bleeding in Patients With or Without Continued Treatment With an Antithrombotic Agent

Objectives We prospectively investigated the risk of colonoscopy‐related bleeding in relation to antithrombotic treatment. Methods This prospective, observational, single‐center cohort study (NCT02594813) enrolled consecutive patients who underwent colonoscopy, including the removal of colorectal polyps, regardless of the continuation of antithrombotic treatment. The primary outcome measure was delayed bleeding in the patients who underwent a hot snare polypectomy and/or endoscopic mucosal resection in addition to a cold snare polypectomy (CSP) and required endoscopic treatment ≤2 weeks after the procedure. Secondary outcomes were immediate bleeding and the number of hemostatic clips used during the procedure. Results From January 2019 to December 2023 at our institution, 1562 (mean age 75 years) and 15,769 (mean age, 64 years) patients underwent colonoscopy with or without antithrombotic treatment, respectively. Immediate bleeding following the removal of colorectal polyps, regardless of the polypectomy technique, occurred in 173 (33.86%) of the 511 patients with antithrombotic treatment, which was significantly more frequent than in 439 (9.44%) of the 4651 patients without antithrombotic treatment ( p < 0.001). On the other hand, there was no significant difference in delayed bleeding after CSP between the two groups (0.41% vs. 0.11%, p = 0.15). However, the incidence of delayed bleeding following polypectomy was significantly higher in patients receiving antithrombotic treatment compared to those without it (seven of 511 [1.37%] vs. 12 of 4651 [0.26%], p = 0.0016). Conclusions The risk of delayed bleeding after colonoscopy with removal of colorectal polyps was low despite continuation of antithrombotic therapy. www.clinicaltrials.gov (NCT02594813).