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

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.