The Role of Prophylactic Hemoclips to Prevent Delayed Post-Polypectomy Bleeding in Patients on Chronic Anticoagulation: A Large University-Based Experience: 709

Introduction: Post-polypectomy bleeding is the most common complication that arises after removal of colon polyps. Recent data suggests that prophylactic hemoclip placement may not provide benefit in reducing post-polypectomy bleeding rates. Our aim was to assess whether patients who received prophylactic hemoclips while concurrently receiving anticoagulation or anti-platelet therapy were less likely to present with a post-polypectomy bleed. Methods: We retrospectively reviewed electronic medical records of all adult patients who had a colonoscopy with polypectomy between June 2012 and April 2014 at our tertiary care center. Post-polypectomy bleeding (PPB) was defined as any presentation for lower gastrointestinal bleeding symptoms within 30 days of colonoscopy with evidence of PPB on colonoscopy. Patients were recorded as having been on anticoagulation (AC) or anti-platelet therapy (APT) if documented in a pre-procedure note or medication reconciliation. A 2-way analysis of variance (ANOVA) was used to demonstrate significance in PPB among patients who received prophylactic hemoclip with or without concurrent anticoagulation. Results: Eight hundred patients underwent polypectomy for a total of 2,268 polyps removed; 12 cases (1.5%) were complicated by a PPB. There were a total of 60 prophylactic hemoclips applied, of which 29 patients were receiving concurrent AC or APT. In patients who bled, there was no difference in those who underwent prophylactic hemoclip placement compared to patients without clip (p=0.24). Similar findings were also observed in patients either on or not on AC or APT at the time of colonoscopy (p=0.15). However, when analyzing the combined effects of prophylactic hemoclip placement and concurrent AC or APT, there were less patients who bled (p=0.044). Patients who bled were more likely to have had hot snare and cold biopsy forceps performed compared to cold snare (11 vs. 1). About half of PPB came from large polyps (>1 cm), of which (83%) did not receive a prophylactic hemoclip compared to 96.5% of large polyps that did not bleed after clip placement (p≤0.0001). Conclusion: Our results suggest that the mere placement of prophylactic hemoclips does not significantly reduce the rate of post-polypectomy bleeding, but when placed in patients receiving anticoagulation or anti-platelet therapy there may be some benefit in PPB rates. In addition, polypectomy technique and polyp size may also play a role in the rate of PPB. However, given the small number of our PPB cases, this warrants further study.