Cold Snare Resection of Small Polyps Is Safe in Patients on Anticoagulants

Cold snare polypectomy (CSP) is the standard of care for small and diminutive colorectal polyps (collectively <1 cm) because it is effective and avoids the risks associated with electrocautery, including delayed postpolypectomy bleeding. However, the safety of CSP in patients on anticoagulants is unclear.

In a randomized, controlled, noninferiority trial, investigators assessed the incidence of major bleeding (poorly controlled intraprocedural bleeding or bleeding requiring endoscopic hemostasis up to 28 days later) after resection of subcentimeter non-pedunculated polyps. They randomized 184 patients on warfarin or direct-acting oral anticoagulants to uninterrupted anticoagulation with CSP or heparin bridging with hot snare polypectomy.

The …