Related Experiment Videos
Is Routine Interruption of Direct Oral Anticoagulants Necessary during Colorectal Endoscopic Mucosal Resection and
Yutaka Okagawa1, Masanori Sato1,2, Masahiro Hirakawa1,3
1Division of Medical Oncology, Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Journal of Gastroenterology and Hepatology
|July 13, 2026
Summary
Continuing direct oral anticoagulants (DOACs) during colorectal endoscopic mucosal resection (EMR) or hot snare polypectomy (HSP) appears safe, with no significant increase in delayed postpolypectomy bleeding (DPPB) compared to interruption. Further research is needed to confirm optimal management strategies.
Area of Science:
- Gastroenterology
- Cardiology
- Clinical Pharmacology
Background:
- Colorectal endoscopic mucosal resection (EMR) and hot snare polypectomy (HSP) are high-risk procedures for bleeding.
- Current guidelines often recommend interrupting direct oral anticoagulants (DOACs) or using heparin bridging therapy (HBT).
- Limited data directly compare DOAC continuation versus interruption for these procedures.
Purpose of the Study:
- To evaluate whether periprocedural DOAC interruption reduces delayed postpolypectomy bleeding (DPPB) after colorectal EMR/HSP.
- To compare DPPB rates between patients who continued DOACs and those who interrupted them.
Main Methods:
- Retrospective study of 691 patients on DOACs undergoing colorectal EMR or HSP (April 2020-March 2024).
- Patients were divided into DOAC continuation and interruption groups.
- Propensity score matching (PSM) was used to balance clinical variables; 146 matched pairs were analyzed.
Main Results:
- Delayed postpolypectomy bleeding (DPPB) occurred in 4.1% of the interruption group and 2.1% of the continuation group (p=0.501).
- The absolute risk difference was 2.05% (95% CI, -1.90%-6.01%), indicating no statistically significant difference.
- No thromboembolic events were observed in either group.
Conclusions:
- DOAC continuation may not significantly increase DPPB risk compared to a 1-day interruption for colorectal EMR/HSP.
- The study's small number of bleeding events and wide confidence intervals preclude excluding a clinically meaningful difference.
- Further prospective studies are necessary to establish the optimal periprocedural DOAC management strategy.
Related Concept Videos
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:25Endoscopic Procedures II: Colonoscopy
The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections: