Risk of Delayed Post-polypectomy Bleeding in Patients With Antithrombotic Therapy

Recent changes in the perioperative management of antithrombotic therapy (ATT), including the discontinuation of routine heparin bridging and the increased use of cold snare polypectomy, may reduce delayed post-polypectomy bleeding (DPPB) rates. However, few recent studies have evaluated these changes. We compared DPPB rates between patients with and without ATT and explored factors associated with bleeding.

We conducted a retrospective cohort study of adult patients who underwent endoscopic resection of colorectal polyps ≤15 mm between April 2021 and October 2023. DPPB was defined as hematochezia or a hemoglobin drop ≥2.0 g/dL requiring endoscopic hemostasis. Univariable analyses were performed to identify factors associated with DPPB, and exploratory multivariable analyses were conducted.

Among 2136 patients with 7025 polyps, 523 patients (1874 polyps) were receiving ATT. The DPPB rates per patient (1.91% vs. 0.25%) and per lesion (0.69% vs. 0.08%) were significantly higher in the ATT group (p < 0.001). In univariable analyses, ATT use (odds ratio [OR] 7.84), ≥3 resected lesions (OR 5.13), and hypertension (OR 3.95) were significant risk factors in the per-patient analysis, while ATT use (OR 8.73), lesion size >10 mm (OR 4.51), and clipping (OR 5.20) were significant in the per-lesion analysis. Among ATT types, warfarin users had the highest DPPB rates.

Colorectal polypectomy in patients receiving ATT is associated with an increased risk of DPPB. Particular caution is warranted in patients receiving warfarin.

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