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Endoscopic procedures in patients under clopidogrel or dual antiplatelet therapy: a survey among German
A Abdel Samie1, L Theilmann1, J Labenz2
1Department of Gastroenterology, Pforzheim Hospital, Pforzheim, Germany.
Insights
German gastroenterologists often deviate from guidelines when managing patients on clopidogrel or dual antiplatelet therapy undergoing endoscopic procedures. Clinical decisions are individualized due to weak evidence supporting current recommendations.
Area of Science:
- Gastroenterology
- Cardiology
- Clinical Practice Guidelines
Background:
- Guidelines recommend stopping clopidogrel 7 days before high-risk endoscopic procedures due to bleeding risk.
- Premature cessation of clopidogrel can lead to severe cardiovascular events like stent thrombosis.
- Current clinical practices among German gastroenterologists regarding these procedures require assessment.
Purpose of the Study:
- To evaluate the current clinical practices of German gastroenterologists for endoscopic procedures in patients on clopidogrel or dual antiplatelet therapy.
- To identify discrepancies between guideline recommendations and actual clinical decision-making.
Main Methods:
- A 10-item questionnaire was distributed via email to 220 members of the Arbeitsgemeinschaft Leitender Gastroenterologen in Kliniken (ALGК).
- The questionnaire focused on endoscopic procedures in patients undergoing clopidogrel or dual antiplatelet therapy.
- 73 chief gastroenterologists completed and returned the questionnaires.
Main Results:
- A significant majority (85%) of units perform endoscopic biopsies under clopidogrel monotherapy, compared to 41% under dual antiplatelet therapy.
- Polypectomies are performed under clopidogrel monotherapy in 49% of units, versus only 5.5% under dual antiplatelet therapy.
- Despite guidelines, over 60% perform endoscopic sphincterotomies in emergency situations for patients on clopidogrel/dual antiplatelet therapy, and 44% perform percutaneous endoscopic gastrostomy under clopidogrel monotherapy.
Conclusions:
- Current guidelines for endoscopic procedures in patients on clopidogrel/dual antiplatelet therapy are based on weak evidence and expert opinion.
- Clinical decision-making in this patient group is highly individualized.
- There is a lack of robust data to support existing guideline recommendations, highlighting a need for evidence-based practice.
Background:
Because of the higher risk of bleeding, guidelines recommend cessation of clopidogrel seven days prior to high-risk endoscopic procedures. However, premature cessation of clopidogrel may lead to catastrophic cardiovascular sequelae due to stent thrombosis. We aimed to assess the current clinical practice among German gastroenterologists regarding endoscopic procedures in patients under clopidogrel/dual antiplatelet therapy.
Methods:
A 10-item questionnaire on endoscopic procedures in patients under clopidogrel/dual antiplatelet therapy was sent by e-mail to all 220 members of the ALGK.
Results:
73 (33 %) chief gastroenterologists returned completed questionnaires, 35 (48 %) of whom conduct high-volume endoscopic units performing more than 4000 procedures per annum. 62 (85 %) endoscopic units perform endoscopic biopsies under clopidogrel alone, while just in 30 (41 %) departments biopsies are carried out under dual antiplatelet therapy. In 36 (49 %) GI-units endoscopic polypectomy under clopidogrel monotherapy is performed, in contrast to only 4 (5.5 %) in the case of combined antiplatelet therapy. However, in emergency situations more than 60 % of all participants do perform endoscopic sphincterotomy in patients under clopidogrel/dual antiplatelet therapy. Percutaneous endoscopic gastrostomy is carried out in 32 endoscopic units (44 %) under clopidogrel monotherapy, but only in 4 (5.5 %) under dual antiplatelet therapy.
Conclusion:
Current guidelines on endoscopic procedures in patients under clopidogrel/dual antiplatelet therapy are mainly based on expert opinion and therefore, backed by only weak evidence. Our survey shows that in this setting the clinical decision making takes place on an individual basis, as there are no data to support the recommendations of the present guidelines.
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