#VisualAbstract: Continuous Anticoagulation and Cold Snare Polypectomy Versus Heparin Bridging and Hot Snare Polypectomy in Patients on Anticoagulants With Subcentimeter Polyps

1. In this randomized controlled trial, cold snare polypectomy with continuous anticoagulation does not increase bleeding risk when compared to hot snare polypectomy with heparin bridging.

2. The cold snare polypectomy procedure had shorter procedure time per lesion and decreased length of hospital stays in comparison to hot snare polypectomy.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Polypectomy is a procedure utilized to reduce risk of morbidity and mortality associated with colorectal cancer in patients. The authors of this randomized controlled trial compared cold snare polypectomy (CSP) with hot snare polypectomy (HSP) and the risk of bleeding in patients on anticoagulant therapy. CSP does not involve electrocautery and has been found to result in reduced bleeding in patients receiving warfarin. In comparing outcomes between continuous administration of anticoagulants (CA) with CSP (CA + CSP) and periprocedural heparin bridging (HB) with HSP (HB + HSP) for subcentimeter colorectal polyps, no increased bleeding risk was found with CA + CSP. Mean hospitalization period and procedure length were found to be longer in the HB + HSP group.  One of the limitations of this randomized controlled trial was that patients and physicians were not blinded regarding treatment arms. Further, the results may not be fully generalizable to all patients undergoing polypectomy, as only patients with subcentimeter polyps were included in this study.

Click to read the study in Annals of Internal Medicine

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