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

Komatsu, Takao; Tamai, Yoshiko; Takami, Hideki; Yamagata, Kazufumi; Fukuda, Shinsaku; Munakata, Akihiro

doi:10.1007/s00535-005-1613-0

Cited by 38 publications

(31 citation statements)

References 46 publications

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“…Three days after cessation of aspirin (100 mg/day for 7 days), skin bleeding times (including blood loss volume) decreased to values which were not significantly different from the pre-administration values. In contrast to aspirin, 5 days after cessation of ticlodipine and 7 days after cessation of combined aspirin and ticlodipine administration, bleeding times where still slightly elevated, albeit the difference was not significant [7]. Similar findings were demonstrated on 100 patients undergoing elective cardiac surgery.…”

Section: Effect Of Aspirin and Other Drugs On Platelet Functionsupporting

confidence: 70%

“…The editor commented that he requests discontinuation of aspirin 1 week before colonoscopy but still removes polyps if the patients have not complied with that request [51]. In Japan, cessation of antiplatelet therapy before endoscopic procedures is recommended [7]. Some authors suggest ceasing aspirin 7 days before any planned resection of large polyps or when multiple polypectomies are to be performed, and staying off aspirin for 2 weeks after piecemeal resection of large sessile polyps [52].…”

Section: Controversial Policiesmentioning

confidence: 99%

“…The mean interval period between sphincterotomy and delayed bleeding, which was not mentioned in this study, was reported to be 3 days in other studies. Provided that aspirin was not administrated after the sphincterotomy, 10 days of withdrawal ensured that almost all platelets are functional [1,5,6,7,8,9]. …”

Section: Endoscopic Sphincterotomy and Aspirinmentioning

confidence: 99%

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Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures

et al. 2007

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Antiplatelet drugs may increase the risk of bleeding induced by gastrointestinal endoscopic procedures. The antiplatelet effect of cyclooxygenase-1 inhibitors lasts less than 4 h. Skin and colonic bleeding times are prolonged for 3 and 5 days after aspirin and ticlopidine withdrawal respectively. Major bleeding from endoscopic biopsies is extremely rare. In the four recent largest series, the general incidence of polypectomy-induced major bleeding was 0.11–0.42%. In more than half of the cases the bleeding was delayed, usually up to 2 weeks after the endoscopy. Although three retrospective studies suggested that aspirin does not increase the risk of polypectomy-induced bleeding, the power of these studies is limited. Similarly, it is difficult to draw conclusions from the two studies that assessed the risk of aspirin use during sphincterotomy. Aspirin withdrawal may be harmful in susceptible patients, mainly if it is for more than 7 days. There is no indication to stop aspirin before esophagogastroduodenoscopy, which may reveal aspirin-induced lesions. We recommend discontinuation of aspirin 4–7 days (according to the cardiovascular risk) before other endoscopic procedures. When aspirin is indicated for primary prevention, it can be resumed 14 and 10 days after polypectomy and sphincterotomy respectively. In cases of secondary prevention, it should be resumed after 1 week.

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Section: Effect Of Aspirin and Other Drugs On Platelet Functionsupporting

confidence: 70%

Section: Controversial Policiesmentioning

confidence: 99%

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Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures

et al. 2007

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“…A procedure with a low risk of bleeding is considered in the guideline of ASGE to require no cessation period. In contrast, even if the procedural risk is classified as low, cessation is recommended before endoscopy in the JGES guideline based on the solitary study about optimal cessation period [16]. Additionally, racial differences in risk of bleeding and forms of thromboembolism confuse the situation [17].…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis on the management of anticoagulants and antiplatelet agents for scheduled endoscopy

et al. 2009

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“…The feature of these guidelines is that the risk of procedure-related bleeding is more heavily weighted than the risk of a thromboembolism caused by ceasing these medications, based on the solitary study [11]. In these guidelines, cessation is recommended even for scheduled esophagogastroduodenoscopy (EGD) including biopsy, although cessation is not indicated as necessary in most western guidelines [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Clinical management of esophagogastroduodenoscopy by clinicians under the former guidelines of the Japan Gastroenterological Endoscopy Society for patients taking anticoagulant and antiplatelet medications

et al. 2014

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Background The 2005 Japan Gastroenterological Endoscopy Society (JGES) guidelines for the management of antithrombotic drugs focused on the increasing risks of bleeding, even from biopsy during scheduled esophagogastroduodenoscopy (EGD). The new 2012 guidelines emphasized the prevention of thromboembolic complications. To compare with the new guidelines, we investigated the clinical management of EGD by clinicians under the former JGES guidelines for patients taking antithrombotic agents. Methods Medical records of 4574 patients (mean age 63.4 years, range 3-96 years, male/female ratio 2805/1769) who underwent scheduled EGD from April 2011 to March 2012 were reviewed retrospectively. The prescribed agents, pre-existing comorbidities, drug cessation before EGD, bleeding, and thromboembolic complications were investigated. Results Five hundred forty-six patients (12.0 %) were taking antithrombotic drugs (aspirin, 313; warfarin, 134; cilostazol, 57; clopidogrel, 59; ethylicosapentate, 40; prostaglandin preparations, 41; ticlopidine, 29; icosapentate, 24; dipyridamole, 4); 116 and 29 patients, respectively, were managed with a combination of 2 or 3 agents. Among 490 patients whose medical records were precisely documented, 40.6 % underwent EGD without cessation.Bleeding and thromboembolic complications were not observed. The most common pre-existing comorbidity was ischemic heart disease (27.9 %), followed by carotid or intracranial large artery atherosclerosis (20.5 %), cerebral infarction or transient ischemic attack (20.3 %), and atrial fibrillation (15.9 %). Patients with pre-existing comorbidity requiring anticoagulants frequently underwent EGD without cessation. Conclusion We revealed the low impact of the 2005 JGES guidelines on the management of antithrombotic drugs. Our physicians have reasonably decided to continue antithrombotic drugs before EGD according to the risk of thromboembolism.

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

Abstract: A 3-day cessation period for ASA, a 5-day cessation period for TP, and a 7-day cessation period for ASA+TP administration seem to be sufficient.

Cited by 38 publications

References 46 publications

Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures

Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures

Retrospective analysis on the management of anticoagulants and antiplatelet agents for scheduled endoscopy

Clinical management of esophagogastroduodenoscopy by clinicians under the former guidelines of the Japan Gastroenterological Endoscopy Society for patients taking anticoagulant and antiplatelet medications

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