Colonoscopic Polypectomy in Patients Receiving Anticoagulation Therapy: Some Like It Cold
Authors: Jeffrey L. Tokar, Michael J. Bartel
Journal: Annals of Internal Medicine (2019)

Editorials20 August 2019Colonoscopic Polypectomy in Patients Receiving Anticoagulation Therapy: Some Like It ColdJeffrey L. Tokar, MD and Michael J. Bartel, MDJeffrey L. Tokar, MDFox Chase Cancer Center, Philadelphia, Pennsylvania (J.L.T., M.J.B.)Search for more papers by this author and Michael J. Bartel, MDFox Chase Cancer Center, Philadelphia, Pennsylvania (J.L.T., M.J.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1708 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Despite best efforts, medical and surgical interventions have inherent risks, and colonoscopy is no exception. Although colonoscopic complications (such as bleeding) are uncommon among persons with average risk, the chances of them occurring increase when polypectomy is performed, particularly in patients receiving antithrombotic medications. Polypectomy risk may be influenced further by tool selection, removal technique (by fluid injected submucosally beneath the polyp, electrical current, or both), technical proficiency, and periprocedural antithrombotic management decisions.Many professional societies advocate temporary withdrawal of oral anticoagulants and case-by-case decision making regarding heparin bridging (HB) on the basis of a patient's estimated risk for thromboembolic ...References1. Douketis JD, Spyropoulos AC, Kaatz S, et al; BRIDGE Investigators. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373:823-33. [PMID: 26095867] doi:10.1056/NEJMoa1501035 CrossrefMedlineGoogle Scholar2. Lin D, Soetikno RM, McQuaid K, et al. Risk factors for postpolypectomy bleeding in patients receiving anticoagulation or antiplatelet medications. Gastrointest Endosc. 2018;87:1106-1113. [PMID: 29208464] doi:10.1016/j.gie.2017.11.024 CrossrefMedlineGoogle Scholar3. 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Endosc Int Open. 2017;5:E184-E189. [PMID: 28331902] doi:10.1055/s-0043-101696 CrossrefMedlineGoogle Scholar7. Takeuchi Y, Mabe K, Shimodate Y, et al. Continuous anticoagulation and cold snare polypectomy versus heparin bridging and hot snare polypectomy in patients on anticoagulants with subcentimeter polyps. A randomized controlled trial. Ann Intern Med. 2019;171:229-37. doi:10.7326/M19-0026 LinkGoogle Scholar8. Arimoto J, Chiba H, Ashikari K, et al. Safety of cold snare polypectomy in patients receiving treatment with antithrombotic agents. Dig Dis Sci. 2019. [PMID: 30684074] doi:10.1007/s10620-019-5469-1 Google Scholar9. Shioji K, Suzuki Y, Kobayashi M, et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2003;57:691-4. [PMID: 12709699] CrossrefMedlineGoogle Scholar10. Pohl H, Grimm IS, Moyer MT, et al. Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology. 2019. doi:10.1053/j.gastro.2019.03.019 CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Fox Chase Cancer Center, Philadelphia, Pennsylvania (J.L.T., M.J.B.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1708.Corresponding Author: Jeffrey L. Tokar, MD, Fox Chase Cancer Center, Department of Medicine, 333 Cottman Avenue, Philadelphia, PA 19111; e-mail, jeffrey.[email protected]edu.Current Author Addresses: Dr. Tokar: Fox Chase Cancer Center, Department of Medicine, 333 Cottman Avenue, Philadelphia, PA 19111.Dr. Bartel: 738 Market Street, Apartment 704, Philadelphia, PA 19106.This article was published at Annals.org on 16 July 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoContinuous Anticoagulation and Cold Snare Polypectomy Versus Heparin Bridging and Hot Snare Polypectomy in Patients on Anticoagulants With Subcentimeter Polyps Yoji Takeuchi , Katsuhiro Mabe , Yuichi Shimodate , Shinji Yoshii , Shinya Yamada , Mineo Iwatate , Takuji Kawamura , Kinichi Hotta , Koji Nagaike , Nobuaki Ikezawa , Tomoaki Yamasaki , Yoriaki Komeda , Satoshi Asai , Yasuhiro Abe , Takuji Akamatsu , Yuko Sakakibara , Hisatomo Ikehara , Yuzuru Kinjo , Takashi Ohta , Yoko Kitamura , Takashi Shono , Takuya Inoue , Yoshio Ohda , Nozomu Kobayashi , Tokuma Tanuma , Ryu Sato , Taku Sakamoto , Naohiko Harada , Akiko Chino , Hideki Ishikawa , Masanori Nojima , Toshio Uraoka , and Metrics 20 August 2019Volume 171, Issue 4Page: 285-286KeywordsAnticoagulantsColonoscopyHemorrhageHemostaticsHeparinOdds ratioPolypectomiesSafetySafety studiesThromboembolism ePublished: 16 July 2019 Issue Published: 20 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. 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