Is Routine Interruption of Direct Oral Anticoagulants Necessary during Colorectal Endoscopic Mucosal Resection and...

Colorectal endoscopic mucosal resection (EMR) and hot snare polypectomy (HSP) are high-bleeding-risk endoscopic procedures, and most clinical guidelines recommend stopping direct oral anticoagulants (DOACs) temporarily or switching to heparin-bridging therapy (HBT). However, existing evidence is largely derived from cohorts that combine warfarin and DOAC users or include substantial use of HBT, and data directly comparing the continuation versus interruption of DOACs are limited. We aimed to assess whether periprocedural DOAC interruption reduces delayed postpolypectomy bleeding (DPPB) in patients undergoing EMR/HSP.

Consecutive patients receiving DOAC therapy who underwent colorectal EMR or HSP between April 2020 and March 2024 were included in this retrospective study. The patients were classified into continuation and interruption groups following periprocedural DOAC management. Propensity score matching (PSM) was conducted using clinically relevant variables. The primary outcome was DPPB within 28 days.

Overall, 691 patients who were receiving DOACs underwent EMR/HSP, and 146 matched pairs were analyzed. After PSM, covariate balance between the groups was improved. DPPB occurred in six patients (4.1%) in the interruption group and three patients (2.1%) in the continuation group (p = 0.501; absolute risk difference: 2.05% [95% confidence interval, -1.90%-6.01%]). No thromboembolic events were observed.

DOAC continuation may not substantially increase DPPB risk compared with 1-day DOAC interruption in patients undergoing colorectal EMR/HSP. However, the small number of bleeding events and wide confidence intervals mean that a clinically meaningful difference cannot be excluded. Further prospective studies are needed to determine the optimal periprocedural DOAC management strategy.