Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians
| Autor: | Carla Satorres Paniagua, Gema Plumé Gimeno, Marco Bustamante-Balén, Maria José Cejalvo Andújar, Francia Carolina Díaz Jaime |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Evidence-based practice Medication Therapy Management medicine.medical_treatment Colonic Polyps Guidelines as Topic 030204 cardiovascular system & hematology Colonic polyps Gastrointestinal hemorrhage Endoscopy Gastrointestinal law.invention 03 medical and health sciences 0302 clinical medicine Polyps Randomized controlled trial law Medication therapy management Medicine Humans lcsh:RC799-869 Intensive care medicine Evidence-Based Medicine business.industry Rectal Neoplasms Gastroenterology Antiplatelet agents General Medicine Evidence-based medicine Colonoscopy Clopidogrel Polypectomy Surgery Platelet aggregation inhibitor 030211 gastroenterology & hepatology Observational study lcsh:Diseases of the digestive system. Gastroenterology business Gastrointestinal Hemorrhage Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Revista Espanola de Enfermedades Digestivas, Vol 109, Iss 1, Pp 49-59 Revista Española de Enfermedades Digestivas v.109 n.1 2017 SciELO España. Revistas Científicas Españolas de Ciencias de la Salud instname REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS r-FISABIO: Repositorio Institucional de Producción Científica Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) Revista Española de Enfermedades Digestivas, Volume: 109, Issue: 1, Pages: 49-59, Published: JAN 2017 |
| ISSN: | 1130-0108 |
| Popis: | Due to the rising prevalence of coronary heart disease, endoscopists are more frequently performing a polypectomy in patients on antiplatelet therapy (APT) and dual antiplatelet therapy (DATP). Despite the availability of several guidelines with regard to the management of antiplatelet drugs during the periprocedure period, there is still variability in the current clinical practice. This may be influenced by the low quality of the evidence supporting recommendations, because most of the studies dealing with APT and polypectomy are observational and retrospective, and include mainly small (< 10 mm) polyps. However, some recommendations can still be made. An estimation of the bleeding and thrombotic risk of the patient should be made in advance. In the case of DAPT the procedure should be postponed, at least until clopidogrel can be safely withheld. If possible, non-aspirin antiplatelet drugs should be withheld 5-7 days before the procedure. Polyp size is the main factor related with post-polypectomy bleeding and it is the factor that should drive clinical decisions regarding the resection method and the use of endoscopic prophylactic measures. Non-aspirin antiplatelet agents can be reintroduced 24-48 hours after the procedure. In conclusion, there is little data with regard to the management of DAPT in patients with a scheduled polypectomy. Large randomized controlled trials are needed to support clinical recommendations. |
| Databáze: | OpenAIRE |
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