[Should platelet inhibitors be discontinued before gastrointestinal endoscopy?].
BACKGROUND
. In Norway, different attitudes prevail to discontinuation of antiplatelet agents, such as ASA, NSAID, ADP-receptor inhibitors (clopidogrel and ticlopidine) phosphodiestase inhibitors (dipyridamole) and glycoprotein IIb/IIIa receptor inhibitors (abciximab and eptifibatide), before endoscopic procedures. The Norwegian Association of Gastroenterology have appointed a group, consisting of a medical and a surgical gastroenterologist, a haematologist, a cardiologist and a pharmacologist, to review literature concerning the issue in order to give a recommendation.


METHODS
Literature retrieved from a non-systematic search of Pubmed was critically reviewed by the study group.


RESULTS
No randomised controlled studies were found to have addressed the problem. Two prospective and three retrospective studies have compared the frequency of bleeding complications for patients using or not using ASA/NSAID during endoscopic papillotomy or polypectomy. The studies showed either no differences in bleeding complications, or only an increase in mild, self-limiting haemorrhage for those using ASA/NSAID.


CONCLUSIONS
The group recommends that all gastroenterological procedures may be performed on patients taking ASA/NSAID provided there are no pre-existing bleeding disorders. As no clinical data are available for other antiplatelet agents, the group recommends to stop the treatment for 7 days before the procedure, but this will have to be balanced against the risk of thrombosis associated with the discontinuation.
Hofstad
Bjørn
B
Gastromedisinsk avdeling Ullevål universitetssykehus 0407 Oslo. bjho@uus.no
Nesbakken
Arild
A
Eritsland
Jan
J
Brørs
Odd
O
Sandset
Per Morten
PM
D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin