Management of Anticoagulated Patients with Heavy Bleeding Undergoing Dilatation and Curettage with Polypectomy

Anticoagulation Management Strategies

The British Society of Haematology recommends omitting the morning dose of Direct Oral Anticoagulants (DOACs) on the day of the procedure to minimize hemorrhagic complications 1
DOACs have unpredictable anticoagulant effects at the time of endoscopy due to variable peak levels, and there is no reliable test to measure anticoagulation, according to the British Society of Haematology 1, 2
The American College of Cardiology suggests that warfarin users should avoid heparin bridging, as it is associated with significantly higher bleeding rates (12.0% with bridging vs 4.7% without) 3, 4
The British Society of Haematology recommends that aspirin monotherapy can be safely continued during polypectomy procedures 3, 5

The American College of Cardiology strongly prefers the cold snare technique for patients on anticoagulation, as it dramatically reduces bleeding risk 3, 2, 4
The British Society of Haematology suggests that prophylactic clipping after polypectomy may reduce bleeding risk, though evidence is mixed 6

The American College of Cardiology states that polyp size >1 cm significantly increases bleeding risk (adjusted OR 4.5, 95% CI 2.0-10.3) 7
The American College of Cardiology recommends that comorbidities, such as diabetes, coronary artery disease, hypertension, and COPD, increase the risk of bleeding 8, 7

The British Society of Haematology suggests that if heavy bleeding is causing hemodynamic instability or significant anemia, proceed urgently with D&C and polypectomy 1, 6
The American College of Cardiology recommends optimizing anticoagulation timing by omitting the morning dose of DOACs on the procedure day and checking INR if time permits for warfarin users 1, 3, 4

The American College of Cardiology recommends restarting anticoagulation cautiously, ideally after 1-2 weeks if clinically feasible, and monitoring for delayed bleeding 8, 7