Safety of cold snare polypectomy with continued direct-acting oral anticoagulation: a multicentre retrospective...

Balancing thromboembolic and bleeding risks in patients on direct-acting oral anticoagulants (DOACs) undergoing cold snare polypectomy (CSP) remains a clinical challenge. Current Western guidelines recommend withholding DOACs 2-5 days before such procedures, despite limited supporting evidence. Emerging studies, particularly from Japan, suggest CSP may be safely performed with minimal or no interruption of DOAC therapy, particularly for polyps ≤10 mm.

This retrospective multicentre cohort study analysed 308 patients (990 polyps) on DOAC therapy who had undergone CSP between 2016 and 2023 in Australia. Patients were categorised into three groups: continued DOAC therapy, withholding only on the morning of the procedure (MOP) and withholding for ≥48 h. The primary outcome was the incidence of early delayed post-polypectomy bleeding (EDPPB) within 48 h. Secondary outcomes included intraprocedural bleeding, delayed post-polypectomy bleeding (DPPB) after 48 h and up to 30 days and thromboembolic events.

EDPPB occurred in 0.32% (1/308) of patients, exclusively in the group withholding DOACs for ≥48 h. No cases of EDPPB or DPPB were observed in patients continuing DOAC therapy or withholding it only on the MOP. Intraprocedural bleeding rates were low and comparable across groups. No thromboembolic events or cases of DPPB were reported. CSP for polyps >10 mm also demonstrated no significant increase in bleeding.

Continuing or minimally interrupting DOAC therapy during CSP for polyps ≤10 mm appeared safe in this cohort, with no significant increase in bleeding or thromboembolic events. Larger, prospective studies are warranted to confirm these results and inform future practice.