Cold snare resection safe in patients on continuous clopidogrel and aspirin, suggests study

A new study published in the journal of Gastrointestinal Endoscopy found the safety of cold snare resection in individuals treated with continuous clopidogrel and aspirin. 2 well-established methods for removing colorectal lesions include underwater resection (polypectomy) and conventional endoscopic mucosal resection (EMR).

Despite being a more recent technique, underwater resection is safe and efficient, and it has benefits over traditional EMR, such as quicker resection and lower resource use. One technique that has a significant risk of bleeding is polypectomy. While it is advised to stop taking clopidogrel 5 to 7 days before polypectomy and the guidelines advise continuing to take aspirin throughout the procedure. The cold snare resection technique, with or without submucosal injection, is thought to be safer when compared to traditional polypectomy with electrocoagulation for post-polypectomy bleeding. Thus, Tae-Geun Gweon and colleagues carried out this investigation to compare the bleeding problems linked to cold snare resection between users of aspirin and clopidogrel.

Users of aspirin and clopidogrel who had polypectomy were included in this multicenter, prospective cohort research, which was carried out at 5 university hospitals in Korea. Antiplatelet agents were used continuously, with continuous usage defined as ≤ 3 days of interruption. In contrast to acute bleeding, which required hemostasis 2 minutes after polypectomy, delayed bleeding was the main goal and was defined as bleeding that occurred many hours after polypectomy. For every polyp, risk factors for rapid bleeding were examined.

A total of 263 of the 509 individuals (n = 129 on clopidogrel and n = 134 on aspirin) had polypectomies. Noninferiority was met by the rates of delayed bleeding per patient in the clopidogrel and aspirin groups, which were 0.8% and 0.7%, respectively (rate difference 0.03% [95% CI: –2.07% to 2.13%]). 100 patients (19.8%) who had polypectomy attained hemostasis. Female sex, end-stage renal illness, submucosal injection prior to resection, and polyp size > 5 mm were all risk factors for immediate hemorrhage.

Overall, the safety of cold snare resection methods for removing small colon polyps in people taking aspirin and clopidogrel continuously was confirmed by a recent study. The noninferiority of this study was supported by similar rates of delayed bleeding, which was 0.8% for clopidogrel users and 0.7% for aspirin users. Female sex, end-stage renal illness, submucosal injection, and polyp size > 5 mm were risk factors for rapid hemorrhage.

Source:

Gweon, T.-G., Kim, H. G., Jung, Y., Jeon, S. R., Na, S.-Y., Lee, Y. J., & Kim, T. H. (2024). Safety of cold snare resection techniques for removal of small colon polyps in patients with clopidogrel and aspirin: A Korean Association for the Study of Intestinal Diseases prospective, multicenter study. In Gastrointestinal Endoscopy. Elsevier BV. https://doi.org/10.1016/j.gie.2024.10.014