Stopping Direct Oral Anticoagulants on the Day of Colonoscopy Was Enough to Prevent Bleeding After Cold Snare Polypectomy
Douglas K. Rex, MD, MASGE, reviewing Morita A, et al. Gastrointest Endosc 2022 Jan 18.
Direct oral anticoagulants (DOACs) are often stopped a couple of days before colonoscopy and resumed one or more days after the procedure, depending on thromboembolism risk and the procedure performed. In Japan, it is recommended to withhold DOACs only on the day of the procedure.
In a Japanese single-center observational study, one group of patients studied over 2 years continued their DOAC therapy when they underwent cold snare polypectomy, and another group studied during a subsequent 2-year period withheld DOAC therapy only on the day of the procedure. In the group that continued DOACs, immediate postpolypectomy bleeding longer than 30 seconds occurred in 12 of 47 patients (25.5%) versus 4 of 66 (6.1%) (P<.008) in the group that withheld DOACs on the day of the procedure. Clips were used in 31.9% of the DOAC-continued group versus 9.1% in the DOAC-withheld group (P=.005). Also, delayed bleeding occurred in 4 of 47 patients (8.5%) from the DOAC-continued group versus 0 of 66 (0%) from the DOAC-withheld group (P<.001).
COMMENTThese data suggest that withholding DOACs on the day of colonoscopy only, as recommended in the Japanese guideline, is sufficient to prevent delayed hemorrhage. Randomized controlled trials of the various strategies of DOAC management would be useful.
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.
CITATION(S)
Morita A, Horiuchi I, Tanaka N, Takada H, Graham DY, Horiuchi A. Managing bleeding risk following cold snare polypectomy in patients receiving direct-acting oral anticoagulants. Gastrointest Endosc 2022 Jan 18. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2022.01.005)
