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Risk of Delayed Post-polypectomy Bleeding in Patients With Antithrombotic Therapy
Rumiko Tsuboi1, Satohiro Matsumoto1, Makiko Mieno2
1Department of Gastroenterology Jichi Medical University Saitama Medical Center Saitama Japan.
DEN Open
|August 12, 2026
Summary
Patients on antithrombotic therapy (ATT) have higher rates of delayed post-polypectomy bleeding (DPPB) after colorectal procedures. Warfarin users require particular caution due to elevated DPPB risks.
Area of Science:
- Gastroenterology
- Endoscopy
- Cardiology
Background:
- Perioperative antithrombotic therapy (ATT) management has evolved, with reduced heparin bridging and increased cold snare polypectomy.
- Few studies have assessed the impact of these ATT changes on delayed post-polypectomy bleeding (DPPB).
Purpose of the Study:
- To compare DPPB rates in patients with and without ATT undergoing colorectal polypectomy.
- To identify factors associated with DPPB in this patient population.
Main Methods:
- Retrospective cohort study of adult patients undergoing colorectal polyp resection (≤15 mm) from April 2021 to October 2023.
- DPPB defined as hematochezia or hemoglobin drop ≥2.0 g/dL requiring endoscopic hemostasis.
- Univariable and exploratory multivariable analyses were conducted to identify risk factors.
Main Results:
- DPPB rates were significantly higher in patients on ATT (1.91% per patient, 0.69% per lesion) compared to those not on ATT (0.25% per patient, 0.08% per lesion).
- ATT use, multiple resected lesions, and hypertension were significant risk factors for DPPB per patient.
- ATT use, larger lesion size (>10 mm), and clipping were significant risk factors per lesion.
- Warfarin users exhibited the highest DPPB rates among ATT types.
Conclusions:
- Colorectal polypectomy in patients on ATT is associated with a significantly increased risk of DPPB.
- Specific vigilance is necessary for patients on warfarin due to their elevated risk of DPPB.
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