title: Management of antithrombotic agents for colonoscopic polypectomies in Israeli gastroenterologists relative to published guidelines.
abstract: BACKGROUND
  Endoscopic procedures are commonly performed in patients taking antithrombotic agents.
  
  
  OBJECTIVE
  To examine the correlation between the management of antithrombotic drugs for colonoscopic polypectomies and the published guidelines.
  
  
  METHODS
  A structured survey delivered to gastroenterologists in 15 major Israeli hospitals and three central HMO clinics.
  
  
  RESULTS
  We collected 100 filled out surveys. Polypectomies on aspirin were performed by 78%. Most physicians did not perform polypectomies on clopidogrel. None of the physicians performed polypectomies on warfarin. Cessation of aspirin for ≥ 3 days post-polypectomy was recommended by 60%. Renewal of LMWH or warfarin was recommended ≥ 2 days post-polepectomy in 91% and 71%, respectively. The greatest variation in recommendations was found for clopidogrel, where the majority of gastroenterologists advised renewal after 1-2 days (38%). Years in practice and increasing colonoscopy volume work had no significant association with management of antithrombotic agents. Working in a HMO clinic was associated with lower rates of polypectomies on aspirin (P=0.036).
  
  
  CONCLUSIONS
  When the guidelines are clear, most gastroenterologists practice according to the existing recommendation. However, lack of prospective studies limits the ability to publish evidence-based recommendation and guidelines. We found that the practice of our cohort study varies in these situations.
authors.affiliation: Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: carterd@zahav.net.il.
authors.forename: Dan
authors.initials: D
authors.lastname: Carter
authors.forename: Marc
authors.initials: M
authors.lastname: Beer-Gabel
authors.forename: Rami
authors.initials: R
authors.lastname: Eliakim
authors.forename: Ben
authors.initials: B
authors.lastname: Novis
authors.forename: Benjamin
authors.initials: B
authors.lastname: Avidan
authors.forename: Eytan
authors.initials: E
authors.lastname: Bardan
mesh_terms: D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005762:Gastroenterology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006761:Hospitals; D006801:Humans; D007557:Israel; D016015:Logistic Models; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: ASGE; American Society for Gastrointestinal Endoscopy; ESGE; European Society for Gastrointestinal Endoscopy; GI; Gastrointestinal; HMO; Health maintenance organization; LWMH; Low molecular weight heparin; NSAID; Non-steroidal anti-inflammatory drugs