Cold snare with continuous anticoagulants does not increase bleeding in small polypectomies

SAN DIEGO — Patients who underwent cold snare polypectomy while taking continuous anticoagulants did not experience increased incidence of severe bleeding compared with those who underwent hot snare polypectomy with heparin bridging, according to research presented at Digestive Disease Week.

In his presentation, Yuichi Shimodate, of the Kurashiki Institute in Japan, said heparin bridging has been the standard of care for peri-polypectomy management in patients who are on anticoagulants, but they do not come without risk.

“It is reported the heparin bridging has a significant risk of GI bleeding after polypectomy,” he said. “So, continuous administration of oral anticoagulants can be an alternative strategy to heparin bridging. However, heparin bridging is always compared to discontinuation of oral anticoagulants, and there is no direct comparison between those strategies.”

In a multicenter, randomized, controlled trial, researchers assigned 182 patients who received anticoagulation therapy with warfarin or direct oral anticoagulants to two different treatment groups. The first underwent cold snare polypectomy with continuous anticoagulants (CA+CSP; n = 92), while the other underwent hot snare polypectomy with heparin bridging (HB+HSP; n = 90). Patients in the HB+HSP group discontinued their anticoagulants the morning of the procedure. The primary endpoint was incidence of severe bleeding associated with polypectomy, defined as poorly controlled intraoperative bleeding or post-polypectomy bleeding requiring endoscopic hemostasis.

The occurrence of major bleeding associated with polypectomy was 4.7% in the CA+CSP group (90% CI, 0.9–8.5) compared with 12.1% in the HB+HSP group (90% CI, 6.2–17.9). Immediate bleeding that required endoscopic hemostasis and hematochezia after polypectomy were more common in the CA+CSP group compared with HB+HSP (7.1% vs. 3.9% and 11.8% vs. 8.4%, respectively), but the differences were not significant.

Shimodate said their findings show non-inferiority of continuous anticoagulants and cold snare polypectomy compared with heparin bridging and hot snare polypectomy. They also found that the CA+CSP group also had shorter procedure times and hospitalization periods.

“Cold snare polypectomy with continuous administration of oral anticoagulants can be a standard strategy for removal of small colorectal polyps among patients taking anticoagulants,” Shimodate concluded. - by Alex Young

Reference:

Shimodate, et al. Abstract 476. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: The authors report no relevant financial disclosures.