Prophylactic Clipping to Prevent Postpolypectomy Bleeding After Oral Anticoagulants

Prophylactic clipping is generally considered effective for endoscopic mucosal resection (EMR) defects of lesions ≥20 mm removed with electrocautery and proximal to the splenic flexure. 

This was a propensity score-weighted, retrospective, cohort study performed from 2012 to 2020, during which 1485 polyps were removed from 547 patients receiving anticoagulants. 

There were 615 polyps removed from 285 patients who received prophylactic clipping and 870 polyps removed from 262 patients who did not receive clipping. About half the patients were exposed to warfarin and the other half received direct oral anticoagulants (DOACs). The absolute rates of postpolypectomy bleeding were 10.6% in the prophylactic-clipping group and 4.2% in those without clipping. Prophylactic clipping did not reduce the risk of postpolypectomy bleeding (odds ratio [OR], 1.19), though postprocedure bleeding was associated with hot resection (OR, 9.76). 

In a subgroup analysis, clipping reduced postpolypectomy bleeding in patients receiving DOACs by 64% (P=.015). Prophylactic clipping was associated with lower bleeding risk in DOAC users but a 3-fold higher risk in warfarin users. Clipping was also associated with a lower risk of bleeding in left-sided polyps and when anticoagulant resumption was delayed for ≥2 days.