Review

Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures
ASystematicReview of the Literature and Recommendations
N.A. Kimchi^{a, b}, E. Broide^a, E. Scapa^a, S. Birkenfeld<sup>b

a</sup>Institute of Gastroenterology, Liver Diseases and Nutrition, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, and
^bDepartment of Gastroenterology, Batyamon Medical Center, Clalit Health Services, Bat Yam, Israel

Address of Corresponding Author

Digestion 2007;75:36-45 (DOI: 10.1159/000101565)

  Key Words

• Gastrointestinal endoscopy
• Colonoscopy
• Polypectomy
• Endoscopic sphincterotomy
• Gastrointestinal hemorrhage
• Platelet aggregation inhibitors
• Aspirin

  Abstract

Antiplatelet drugs may increase the risk of bleeding induced by gastrointestinal endoscopic procedures. The antiplatelet effect of cyclooxygenase-1 inhibitors lasts less than 4 h. Skin and colonic bleeding times are prolonged for 3 and 5 days after aspirin and ticlopidine withdrawal respectively. Major bleeding from endoscopic biopsies is extremely rare. In the four recent largest series, the general incidence of polypectomy-induced major bleeding was 0.11-0.42%. In more than half of the cases the bleeding was delayed, usually up to 2 weeks after the endoscopy. Although three retrospective studies suggested that aspirin does not increase the risk of polypectomy-induced bleeding, the power of these studies is limited. Similarly, it is difficult to draw conclusions from the two studies that assessed the risk of aspirin use during sphincterotomy. Aspirin withdrawal may be harmful in susceptible patients, mainly if it is for more than 7 days. There is no indication to stop aspirin before esophagogastroduodenoscopy, which may reveal aspirin-induced lesions. We recommend discontinuation of aspirin 4-7 days (according to the cardiovascular risk) before other endoscopic procedures. When aspirin is indicated for primary prevention, it can be resumed 14 and 10 days after polypectomy and sphincterotomy respectively. In cases of secondary prevention, it should be resumed after 1 week.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Dr. Nimrod Kimchi
Institute of Gastroenterology, Liver Diseases and Nutrition
Assaf Harofeh Medical Center
IL-70300 Zerifin (Israel)
Tel. +972 8 977 9722, Fax +972 8 923 0054, E-Mail nimrodK@asaf.health.gov.il

  Article Information

Published online: April 10, 2007
Number of Print Pages : 10
Number of Figures : 0, Number of Tables : 3, Number of References : 52