Study design of endoscopic polypectomy on clopidogrel (EPOC): A randomised controlled trial

Area of Science:

• Gastroenterology and Cardiology
• Clinical Trials and Evidence-Based Medicine

Background:

• Managing patients on antiplatelet therapy undergoing endoscopic procedures presents a significant challenge due to conflicting risks of thrombotic events and bleeding.
• Current guidelines often recommend temporary interruption of antiplatelet agents, increasing the risk of cardiovascular thrombotic events.

Purpose of the Study:

• To evaluate whether continuing antiplatelet therapy (clopidogrel, prasugrel, or ticagrelor) during elective colonoscopy is non-inferior or superior to temporary interruption.
• To assess the safety and efficacy of continuing antiplatelet therapy in patients undergoing cold snare polypectomy for polyps ≤10 mm, focusing on the need for rescue clips or significant post-polypectomy bleeding.

Main Methods:

• The EPOC trial is a parallel-group, proceduralist-blinded randomized controlled trial.
• Recruiting patients on single or dual antiplatelet therapy (with aspirin) undergoing elective colonoscopy.
• Comparing continuation versus temporary interruption of antiplatelet therapy, with outcomes including endoscopic rescue clips and clinically significant post-polypectomy bleeding after cold snare polypectomy.

Main Results:

• The EPOC trial is currently underway, aiming to recruit 496 subjects per arm.
• This study represents the first randomized controlled trial to directly compare temporary interruption with continuation of antiplatelet therapy in patients undergoing elective colonoscopy.

Conclusions:

• The findings of the EPOC trial will provide crucial evidence to guide the peri-endoscopic management of antiplatelet therapy.
• Establishing the safety and efficacy of continuing antiplatelet agents may reduce cardiovascular risks associated with procedure interruption.