Antiplatelets, anticoagulants, and colonoscopic polypectomy.

Area of Science:

• Gastroenterology
• Cardiology
• Hematology

Background:

• Managing antiplatelet and anticoagulant (antithrombotic) agents during endoscopic procedures presents significant challenges.
• Periendoscopic antithrombotic management requires careful consideration of bleeding risks, particularly postpolypectomy.

Purpose of the Study:

• To provide a state-of-the-art review of best practices for managing antithrombotic agents in the periendoscopic setting.
• To evaluate the risk of immediate and delayed postpolypectomy bleeding in patients undergoing temporary interruption or continuation of antithrombotic therapy.

Main Methods:

• Review of current literature and clinical practice guidelines.
• Evaluation of data on polypectomy techniques (cold snare vs. thermal) and prophylactic hemostatic clip placement.
• Assessment of strategies for managing antiplatelet and anticoagulant agents around endoscopic procedures.

Main Results:

• The optimal management of antithrombotic agents involves balancing the risk of bleeding against the risk of thrombosis.
• Endoscopic techniques like cold snare polypectomy and prophylactic clip placement may reduce postpolypectomy bleeding.
• Clinical decisions should be individualized based on patient-specific risk factors.

Conclusions:

• Safer polypectomy in patients on antithrombotic agents can be facilitated by adhering to evidence-based recommendations.
• A multidisciplinary approach involving gastroenterologists, cardiologists, and hematologists is often beneficial.
• Continued research is needed to refine guidelines for periendoscopic antithrombotic management.