Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians
Due to the rising prevalence of coronary heart disease, endoscopists are more frequently performing a polypectomy in patients on antiplatelet therapy (APT) and dual antiplatelet therapy (DATP). Despite the availability of several guidelines with regard to the management of antiplatelet drugs during...
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doaj-af34663397084928b8230ff296ee733a2020-11-24T23:28:05ZengAran EdicionesRevista Espanola de Enfermedades Digestivas1130-01081091495910.17235/reed.2016.4114/2015S1130-01082017000100007Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for cliniciansGema Plumé0Marco Bustamante-Balén1Carla Satorres2Francia Díaz3María José Cejalvo4Hospital Universitario Doctor PesetHospital Universitario La FeHospital Universitario La FeHospital Universitario La FeHospital Universitario Doctor PesetDue to the rising prevalence of coronary heart disease, endoscopists are more frequently performing a polypectomy in patients on antiplatelet therapy (APT) and dual antiplatelet therapy (DATP). Despite the availability of several guidelines with regard to the management of antiplatelet drugs during the periprocedure period, there is still variability in the current clinical practice. This may be influenced by the low quality of the evidence supporting recommendations, because most of the studies dealing with APT and polypectomy are observational and retrospective, and include mainly small (< 10 mm) polyps. However, some recommendations can still be made. An estimation of the bleeding and thrombotic risk of the patient should be made in advance. In the case of DAPT the procedure should be postponed, at least until clopidogrel can be safely withheld. If possible, non-aspirin antiplatelet drugs should be withheld 5-7 days before the procedure. Polyp size is the main factor related with post-polypectomy bleeding and it is the factor that should drive clinical decisions regarding the resection method and the use of endoscopic prophylactic measures. Non-aspirin antiplatelet agents can be reintroduced 24-48 hours after the procedure. In conclusion, there is little data with regard to the management of DAPT in patients with a scheduled polypectomy. Large randomized controlled trials are needed to support clinical recommendations.http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082017000100007&lng=en&tlng=enColonoscopyColonic polypsAntiplatelet agentsPolypectomyGastrointestinal hemorrhage |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gema Plumé Marco Bustamante-Balén Carla Satorres Francia Díaz María José Cejalvo |
spellingShingle |
Gema Plumé Marco Bustamante-Balén Carla Satorres Francia Díaz María José Cejalvo Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians Revista Espanola de Enfermedades Digestivas Colonoscopy Colonic polyps Antiplatelet agents Polypectomy Gastrointestinal hemorrhage |
author_facet |
Gema Plumé Marco Bustamante-Balén Carla Satorres Francia Díaz María José Cejalvo |
author_sort |
Gema Plumé |
title |
Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians |
title_short |
Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians |
title_full |
Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians |
title_fullStr |
Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians |
title_full_unstemmed |
Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians |
title_sort |
endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians |
publisher |
Aran Ediciones |
series |
Revista Espanola de Enfermedades Digestivas |
issn |
1130-0108 |
description |
Due to the rising prevalence of coronary heart disease, endoscopists are more frequently performing a polypectomy in patients on antiplatelet therapy (APT) and dual antiplatelet therapy (DATP). Despite the availability of several guidelines with regard to the management of antiplatelet drugs during the periprocedure period, there is still variability in the current clinical practice. This may be influenced by the low quality of the evidence supporting recommendations, because most of the studies dealing with APT and polypectomy are observational and retrospective, and include mainly small (< 10 mm) polyps. However, some recommendations can still be made. An estimation of the bleeding and thrombotic risk of the patient should be made in advance. In the case of DAPT the procedure should be postponed, at least until clopidogrel can be safely withheld. If possible, non-aspirin antiplatelet drugs should be withheld 5-7 days before the procedure. Polyp size is the main factor related with post-polypectomy bleeding and it is the factor that should drive clinical decisions regarding the resection method and the use of endoscopic prophylactic measures. Non-aspirin antiplatelet agents can be reintroduced 24-48 hours after the procedure. In conclusion, there is little data with regard to the management of DAPT in patients with a scheduled polypectomy. Large randomized controlled trials are needed to support clinical recommendations. |
topic |
Colonoscopy Colonic polyps Antiplatelet agents Polypectomy Gastrointestinal hemorrhage |
url |
http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082017000100007&lng=en&tlng=en |
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