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Clin Res Hepatol Gastroenterol. 2013 Nov;37(5):514-8. doi: 10.1016/j.clinre.2013.03.010. Epub 2013 May 20.

Management of antithrombotic agents for colonoscopic polypectomies in Israeli gastroenterologists relative to published guidelines.

Author information

1
Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: carterd@zahav.net.il.

Abstract

BACKGROUND:

Endoscopic procedures are commonly performed in patients taking antithrombotic agents.

OBJECTIVE:

To examine the correlation between the management of antithrombotic drugs for colonoscopic polypectomies and the published guidelines.

DESIGN AND SETTINGS:

A structured survey delivered to gastroenterologists in 15 major Israeli hospitals and three central HMO clinics.

RESULTS:

We collected 100 filled out surveys. Polypectomies on aspirin were performed by 78%. Most physicians did not perform polypectomies on clopidogrel. None of the physicians performed polypectomies on warfarin. Cessation of aspirin for ≥ 3 days post-polypectomy was recommended by 60%. Renewal of LMWH or warfarin was recommended ≥ 2 days post-polepectomy in 91% and 71%, respectively. The greatest variation in recommendations was found for clopidogrel, where the majority of gastroenterologists advised renewal after 1-2 days (38%). Years in practice and increasing colonoscopy volume work had no significant association with management of antithrombotic agents. Working in a HMO clinic was associated with lower rates of polypectomies on aspirin (P=0.036).

DISCUSSION:

When the guidelines are clear, most gastroenterologists practice according to the existing recommendation. However, lack of prospective studies limits the ability to publish evidence-based recommendation and guidelines. We found that the practice of our cohort study varies in these situations.

KEYWORDS:

ASGE; American Society for Gastrointestinal Endoscopy; ESGE; European Society for Gastrointestinal Endoscopy; GI; Gastrointestinal; HMO; Health maintenance organization; LWMH; Low molecular weight heparin; NSAID; Non-steroidal anti-inflammatory drugs

PMID:
23702477
DOI:
10.1016/j.clinre.2013.03.010
[Indexed for MEDLINE]
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