Post written by Louis H.S. Lau, MBChB, and Raymond S.Y. Tang, MD, from the Department of Medicine and Therapeutics and the Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong.

The focus of this study was to examine the benefit of prophylactic clipping after colonoscopic polypectomy in high-risk patients using oral anticoagulants.

Postpolypectomy bleeding is a common complication after colonoscopic polypectomy. Although endoscopists often perform prophylactic clipping to reduce bleeding risk, the evidence on this practice is conflicting and not generalizable to high-risk patients using oral anticoagulants. To address this clinical question, we performed a dedicated study with a larger sample size and exclusive patient population using a propensity-score analysis.

In our study, we found that prophylactic clipping was not associated with an overall reduced risk of postpolypectomy bleeding in anticoagulated patients, except in a subgroup of patients using direct oral anticoagulants. On the other hand, hot resection technique and heparin bridging were significant risk factors of delayed bleeding.

Therefore, we suggest that endoscopists apply prophylactic clipping more selectively, maximize the use of cold snare polypectomy, and minimize the unnecessary use of heparin bridging in this special patient population.

Prospective randomized controlled trials are warranted to further investigate and validate the clinical efficacy and economic cost-effectiveness of prophylactic clipping after colonoscopic polypectomy in these high-risk anticoagulated patients.

Study flow diagram.

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