Is Routine Interruption of Direct Oral Anticoagulants Necessary during Colorectal Endoscopic Mucosal…

Cohort studyJournal of gastroenterology and hepatology· Jul 2026

Is Routine Interruption of Direct Oral Anticoagulants Necessary during Colorectal Endoscopic Mucosal Resection and Hot Snare Polypectomy? A Multicenter Propensity-Matched Study.

Yutaka Okagawa, Masanori Sato, Masahiro Hirakawa … Kohichi Takada

GastroenterologyCohort studyClinical practiceQ1IF 3.1

Direct oral anticoagulants continuation not linked to significantly higher delayed bleeding after colorectal polyp removal

Is Routine Interruption of Direct Oral Anticoagulants Necessary during Colorectal Endoscopic Mucosal Resection and Hot Snare Polypectomy? A Multicenter Propensity-Matched Study.

Yutaka Okagawa … Kohichi Takada

Journal of gastroenterology and hepatology · Jul 2026

Background

Colorectal endoscopic mucosal resection (endoscopic mucosal resection) and hot snare polypectomy (hot snare polypectomy) are high-bleeding-risk endoscopic procedures, and most clinical guidelines recommend stopping direct oral anticoagulants (direct oral anticoagulants) temporarily or switching to heparin-bridging therapy (heparin-bridging therapy).

Purpose

We aimed to assess whether periprocedural direct oral anticoagulants interruption reduces delayed postpolypectomy bleeding (delayed postpolypectomy bleeding) in patients undergoing endoscopic mucosal resection/hot snare polypectomy.

Methods

Consecutive patients receiving direct oral anticoagulants therapy who underwent colorectal endoscopic mucosal resection or hot snare polypectomy between April 2020 and March 2024 were included in this retrospective study.

n = 691 patients

Results

no significant bleeding difference between continuing and stopping direct oral anticoagulants

Risk difference 2.05 (95% CI -1.90 to 6.01)

CI crosses the null - not significant

More results

After propensity score matching, covariate balance between the groups was improved.

No thromboembolic events were observed.

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Conclusion · 1 of 3

Direct oral anticoagulants continuation may not substantially increase delayed postpolypectomy bleeding risk compared with 1-day direct oral anticoagulants interruption in patients undergoing colorectal endoscopic mucosal resection/hot snare polypectomy.

Conclusion · 2 of 3

However, the small number of bleeding events and wide confidence intervals mean that a clinically meaningful difference cannot be excluded.

Conclusion · 3 of 3

Further prospective studies are needed to determine the optimal periprocedural direct oral anticoagulants management strategy.

Is Routine Interruption of Direct Oral Anticoagulants Necessary during Colorectal Endoscopic Mucosal Resection and Hot Snare Polypectomy? A Multicenter Propensity-Matched Study.

Is Routine Interruption of Direct Oral Anticoagulants Necessary during Colorectal Endoscopic Mucosal Resection and Hot Snare Polypectomy? A Multicenter Propensity-Matched Study.

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