Management of Anticoagulants before and after Endoscopy

Colonoscopy with Polypectomy in Patients Taking Clopidogrel

“…Optimal management of these patients requires knowledge of the bleeding risks associated with continuation of clopidogrel during colonoscopic polypectomy and the thrombotic risks that patients are exposed to if the medication is interrupted. While there has been significant attention paid to the potential risk of stopping clopidogrel in coronary stent patients, the bleeding risk associated with polypectomy has not been quantified systematically [15][16][17]. This retrospective series of 60 patients demonstrates that the risk of major bleeding is low.…”

Study for determination of the optimal cessation period of therapy with anti-platelet agents prior to invasive endoscopic procedures

“…36 Therefore, in Western countries, where thromboembolism occurs frequently, the American Society for Gastrointestinal Endoscopy (ASGE), in 2002, recommended the continuous use of anti-platelet agents during endoscopic procedures, 6 and many researchers have reported that cessation is unnecessary. [4][5][6][7][8] Under the present conditions where Western countries and Japan have different opinions, it is important to evaluate how to handle anti-platelet agents during invasive endoscopic procedures.…”

“…[4][5][6][7][8] However, in Japan, cessation of therapy with anti-platelet agents prior to endoscopic procedures is recommended, considering the risk of bleeding during the procedure. In Japan, the recommended cessation period of antiplatelet agents prior to an endoscopic procedure has been estimated from the pharmacokinetics of the particular anti-platelet agent and the lifespan of platelets.…”

Optimal timing of anticoagulation pre- and post-colonoscopy with polypectomy

“…The risk of clinically significant post-polypectomy bleeding with the use of aspirin has been reported as low as 0.5% and suspending therapy is usually not recommended [4,6,7,[10][11][12].…”

“…In an attempt to identify predictors of bleeding after polypectomy in patients receiving anticoagulation, Witt et al [8] found that the likelihood of bleeding increased not only with anticoagulation with warfarin [12] but also with each polyp removed (20% with each additional polyp).…”