Periendoscopic management of antithrombotic drugs: Is cold snare polypectomy the answer?

Abstract

Patients undergoing colonoscopy are increasingly taking antithrombotic medication. These patients, who are generally older, also have a higher prevalence of colon polyps. Therefore, it is general practice to modify or discontinue antithrombotic treatment before colonoscopy, to reduce the risk of post-polypectomy bleeding (PPB). However, this modification increases the risk of thrombotic events. Currently, the main clinical guidelines recommend cold-snare resection for polyps smaller than 10mm because of its better safety profile, especially in reducing post-polypectomy bleeding. This reduced PPB rate could open the door to maintaining antithrombotic drugs in patients undergoing colonoscopy. This review aims to evaluate the evidence available so far that may support a modification of current guidelines on the management of antithrombotic drugs in the periendoscopic period.

Keywords: Adverse events; Antithrombotic drugs; Cold snare endoscopic mucosal resection; Cold snare polypectomy; Colorectal polyp; Delayed post-polypectomy bleeding; Eventos adversos; Fármacos antitrombóticos; Hemorragia pospolipectomía; Hemorragia pospolipectomía diferida; Hot snare polypectomy; Polipectomía con asa caliente; Polipectomía con asa fría; Post-polypectomy bleeding; Pólipo colorrectal; Resección mucosa endoscópica con asa fría.