Year 2017 / Volume 109 / Number 1
Review
Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians

49-59

DOI: 10.17235/reed.2016.4114/2015

Gema Plumé Gimeno, Marco Bustamante-Balén, Carla Satorres Paniagua, Francia Carolina Díaz Jaime, Maria José Cejalvo Andújar,

Abstract
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.
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Plumé Gimeno G, Bustamante-Balén M, Satorres Paniagua C, Díaz Jaime F, Cejalvo Andújar M. Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians. 4114/2015


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Publication history

Received: 18/11/2015

Accepted: 14/05/2016

Online First: 04/11/2016

Published: 03/01/2017

Article revision time: 175 days

Article Online First time: 352 days

Article editing time: 412 days


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