{'fraction_non_alphanumeric': 0.025059665871121718, 'fraction_numerical': 0.0062649164677804296, 'mean_word_length': 4.841463414634147, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Heparin Bridging and Hot Snare Polypectomy in Patients on Anticoagulants With Subcentimeter Polyps

What is the problem and what is known about it so far? Patients with polyps (or small growths in the colon) often have them removed to help decrease their risk for colon cancer. This procedure is called a polypectomy. Many patients take blood thinners for various health conditions, such as atrial fibrillation, and these medicines increase the risk for bleeding during polypectomy. The type of polypectomy (cold snare vs. hot snare) itself also may have different risks for bleeding. The guidelines have different recommendations for how blood thinners should be managed when a patient is having a polypectomy. Why did the researchers do this particular study? To compare the bleeding risks for patients who continue to take their blood-thinning medication and have cold snare polypectomy versus patients who stop the anticoagulants, are given heparin for a short period, and then have hot snare polypectomy. Who was studied? The study was conducted in 30 centers in Japan in 184 patients, aged 20 to 80 years, who were taking blood-thinning medications (warfarin, dabigatran, rivaroxaban, apixaban, or edoxaban) and were planning to have a colonoscopy to remove a small polyp (<1 cm). How was the study done? The patients were randomly assigned to 1 of 2 groups. One group received continuous anticoagulation therapy and had cold snare polypectomy (CA+CSP); the other group received heparin bridging therapy and underwent hot snare polypectomy (HB+HSP). Patients in both groups were hospitalized for the procedure. Those in the CA+CSP group were allowed to continue taking their blood thinners as usual before undergoing cold snare polypectomy. Patients in the HB+HSP group stopped taking their blood thinners and were given heparin for a few days before the procedure and for a few days afterward while their regular anticoagulation therapy was restarted. In both groups, the doctors observed the patients to see whether they had any bleeding; if so, they documented it. They also recorded other information about the procedure, such as how long it lasted. The patients had a follow-up visit with the doctor 2 weeks after the procedure. They completed a survey at that time and another one 1 month later. The survey asked questions about side effects, such as pain in the abdomen, bloating, diarrhea, and blood in the stool. What did the researchers find? About 600 polyps were removed during the trial. The rate of bleeding in the CA+CSP group was lower than in the HB+HSP group (approximately 5% vs. 13%). The doctors did not observe poorly controlled bleeding during the procedure in either group. The HB+HSP group had a longer average procedure time and a longer hospital stay than the CA+CSP group. What were the limitations of the study? The researchers studied 2 factors (how the blood thinners were managed and how the polyps were removed) at the same time; as a result, it is hard to know which factor was most responsible for the results of the trial. What are the implications of the study? The bleeding rate was not increased in patients who kept taking their blood thinners and had cold snare polypectomy, and these patients had a shorter procedure time and hospital stay than those who were given heparin and had hot snare polypectomy.