Endoscopic Biopsy in Patients Exposed to Direct Oral Anticoagulants Is Claimed To Be Safe

Endoscopic Biopsy in Patients Exposed to Direct Oral Anticoagulants Is Claimed To Be Safe

Douglas K. Rex, MD, MASGE, reviewing Konishi T, et al. Endosc Int Open 2022 Nov 17.

Patients taking direct oral anticoagulants (DOACs) are often considered to be at increased risk for bleeding after therapeutic endoscopic procedures such as polypectomy and sphincterotomy.  On the other hand, cold biopsy is usually considered safe in these patients. The current study sought to test whether DOAC use during endoscopic biopsy is indeed safe. 

The authors used a Japanese national database that included 2679 patients exposed to DOACs and 129,357 control patients not exposed to DOACs who underwent endoscopic biopsy but did not undergo polypectomy, endoscopic mucosal resection, or endoscopic submucosal dissection. For the study, DOAC use was defined as a prescription within 3 months prior to the procedure. It was not clear whether DOACs had been stopped for the procedure, but the authors suggested this was not common practice in Japan. 

Patients receiving DOACs had more comorbidities. In a propensity score analysis, the odds ratio (OR) for postprocedural hemorrhage was 1.52, which did not quite reach significance. The risk of stroke was 1.0, and patients in the DOAC group were more likely to have been treated with thrombin on the day of the procedure (OR, 1.60), which was interpreted as evidence of more immediate hemorrhage during the procedure.

Douglas K. Rex, MD, FASGE


Overall, these data are reassuring with regard to the risk of bleeding after cold biopsy in patients receiving DOACs, though the increased use of thrombin on the day of the procedure and the nearly statistically significant results for the primary endpoint suggest there is some risk. The absolute risk of delayed hemorrhage after endoscopic biopsy in patients taking DOACs is still somewhat uncertain, and further studies will be needed to better clarify this issue so that we may better guide our patients prior to their endoscopic procedures.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Konishi T, Ono S, Okada A, et al. Comparison of bleeding following gastrointestinal endoscopic biopsy in patients treated with and without direct oral anticoagulants. Endosc Int Open 2022 Nov 17. (Epub ahead of print) (https://doi.org/10.1055/a-1981-2946)

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