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Poor Compliance With Antithrombotic Guidelines Associated With Bad Outcomes

Douglas K. Rex, MD, MASGE, reviewing Jiang W, et al. Clin Gastroenterol Hepatol 2020 Sep 12.

Rates of polypectomy in colonoscopy are high for all indications; therefore, clinicians usually stop antiplatelet and antithrombotic agents other than aspirin prior to colonoscopy and resume the agents shortly after. This approach is endorsed in multiple guidelines. Despite that, several studies have indicated that physician and patient compliance with guidelines is suboptimal, including practices such as unneeded discontinuation of aspirin, discontinuation of other antiplatelet or antithrombotic agents for longer than recommended, or continuation of anticoagulant agents during colonoscopy and polypectomy. 

The current prospective study from Hong Kong included 602 patients undergoing polypectomy and on an antiplatelet or antithrombotic agent, though most were taking only aspirin. Adherence to aspirin recommendations was 98.4%, whereas full adherence for clopidogrel alone was 41.2%, dual antiplatelet therapy (DAPT) was 40%, warfarin was 8.5%, and direct oral anticoagulants (DOACs) was 5.2%. The numbers of patients on DAPT and DOACs were low. Patient compliance with aspirin alone, clopidogrel alone, DAPT, warfarin, and DOACs was 74.8%, 41.2%, 0, 36.2%, and 17.5%, respectively. 

Clinicians’ nonadherence to guidelines was associated with delayed postpolypectomy bleeding (hazard ratio [HR], 3.54), as was the resection of ≥3 polyps (HR, 2.81). Nonadherence to guidelines was also associated with serious cardiovascular events (HR, 15.63).

Douglas K. Rex, MD, FASGE

COMMENT

These results, which differ from previous studies by their prospective collection, indicate that adherence to current guidelines is associated with better protection against both delayed bleeding and thromboembolic events. This is reassuring for the validity of the guidelines, and it indicates the importance of educating clinicians to improve adherence as well as providing clear instructions to patients.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Jiang W, Suen BY, Ho HT, Ching JYL, Chan FKL, Mak JWY. Impact of physicians’ and patients’ compliance on outcomes of colonoscopic polypectomy with anti-thrombotic therapy. Clin Gastroenterol Hepatol 2020 Sep 12. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.09.019)

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