Delayed post-polypectomy bleeding following cold snare polypectomy of lesions <10 mm in patients on high-dose antithrombotic therapy: insights from a Dutch colonoscopy cohort.

Background: Current guidelines state that low-risk polypectomies (cold snare polypectomies of lesions <10 mm) can be safely performed with continuation of single antiplatelet therapy (low-dose antithrombotic therapy [ATT]). The safety of low-risk polypectomies with continuation of an anticoagulant or dual antiplatelet therapy (high-dose ATT) is uncertain. Methods: Data from 31 325 colonoscopies performed at two Dutch endoscopy centers were analyzed. The centers followed different protocols for the management of ATT around colonoscopies. Incidence of delayed post-polypectomy bleeding (DPPB) and thromboembolic events with continuation or discontinuation of different ATTs around colonoscopy were analyzed. Results: The overall incidence of DPPB for colonoscopies with only low-risk polypectomies was 11/12 291 (0.09%). The incidence of DPPB was similar for patients continuing either high- or low-dose ATT (0.58% vs. 0.30%; P = 0.61). Although the incidence of DPPB significantly differed between patients on continued high-dose and no ATT (0.58% vs. 0.07%; P = 0.04), the absolute risk difference was small (0.67%) and the number of patients required to discontinue high-dose ATT to prevent one case of DPPB was estimated at 150. The severity of DPPBs was comparable between all groups. The incidence of thromboembolic events with ATT discontinuation was 2/1098 (0.18%). Conclusion: The risk of DPPB after low-risk polypectomies was similar for patients who continued high- and low-dose ATT. Although higher compared with patients without ATT, the incidence of DPPB with continued high-dose ATT remains very low. Therefore, we suggest continuation of high-dose ATT for colonoscopy indications with a low risk of detecting advanced polyps.