{"id":6892,"date":"2019-11-04T08:23:43","date_gmt":"2019-11-04T07:23:43","guid":{"rendered":"https:\/\/www.endoscopy-campus.com\/?post_type=ec-news&p=6892"},"modified":"2019-11-04T08:23:44","modified_gmt":"2019-11-04T07:23:44","slug":"dual-antiplatelet-therapy-judged-safe-for-cold-snare-polypectomy-%e2%89%a410-mm","status":"publish","type":"ec-news","link":"https:\/\/www.endoscopy-campus.com\/en\/ec-news\/dual-antiplatelet-therapy-judged-safe-for-cold-snare-polypectomy-%e2%89%a410-mm\/","title":{"rendered":"Dual Antiplatelet Therapy Judged Safe for Cold Snare Polypectomy \u226410 mm"},"content":{"rendered":"\n

Douglas K. Rex, MD, FASGE reviewing Won D, et al. Clin Transl Gastroenterol 2019 Oct 10.\u00a0<\/strong><\/em><\/p>\n\n\n\n

Patients on both aspirin and a second antiplatelet agent (dual antiplatelet therapy or DAPT) are usually instructed in the U.S. and Europe to stop thienopyridine therapy for 5 to 7 days before colonoscopy, while continuing aspirin. Patients often resume the second agent one or more days after colonoscopy, depending on procedures performed.<\/p>\n\n\n\n

In a single-center, single-endoscopist, randomized controlled trial from Korea, 42 patients on DAPT (75.9% clopridogel; 21% ticagrelor; and 2.9% prasugrel) with 104 eligible polyps continued DAPT throughout colonoscopy and polypectomy, and 48 patients stopped their second agent one week prior to colonoscopy and resumed it one day after the procedure.<\/p>\n\n\n\n

The DAPT group had an average of 2.5 polyps per patient resected versus 2.2 in the aspirin-only group. About one third of lesions were 6 to 10 mm in size, and 88% were adenomas. <\/p>\n\n\n\n

Intraprocedural bleeding was not different between the groups (4.8% DAPT vs 2.2% aspirin), but the rate of \u201cnonsignificant\u201d hematochezia was 19% with DAPT versus 8.9% with aspirin, (P=0.170), and one patient in the DAPT group required repeat endoscopy and treatment with hemoclips two days after polypectomy. A composite bleeding outcome was significantly more common with DAPT, with polyp size 6 to 10 mm predicting bleeding in a multivariable analysis.<\/p>\n\n\n\n

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COMMENT
The authors concluded that cold snare polypectomy of lesions \u226410 mm in patients on DAPT is safe. I\u2019m not so sure. A 20% rate of \u201cnonsignificant\u201d hematochezia could generate a substantial number of postprocedural phone calls, and a management paradigm resulting in the need for reintervention in 2.4% of patients undergoing polyp resection of lesions \u226410 mm in size would not be ideal. It\u2019s an important issue, and we need larger trials. <\/p><\/blockquote><\/figure>\n\n\n\n

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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. <\/p>\n\n\n\n

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Douglas K. Rex, MD, FASGE <\/p>\n<\/div><\/div>\n\n\n\n

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CITATION(S) <\/h2>\n\n\n\n

Won D, Kim JS, Ji JS, Kim BW, Choi H. Cold snare polypectomy in patients taking dual antiplatelet therapy: a randomized trial of discontinuation of thienopyridines.\u00a0Clin Transl Gastroenterol\u00a0<\/em>2019 Oct 10. (Epub ahead of print) (https:\/\/doi.org\/10.14309\/ctg.0000000000000091<\/a>) <\/p>\n","protected":false},"excerpt":{"rendered":"

Douglas K. Rex, MD, FASGE reviewing Won D, et al. Clin Transl Gastroenterol 2019 Oct 10.\u00a0 Patients on both aspirin and a second antiplatelet agent (dual antiplatelet therapy or DAPT) are usually instructed in the U.S. and Europe to stop thienopyridine therapy for 5 to 7 days before colonoscopy, while continuing aspirin. Patients often resume … Read more<\/a><\/p>\n","protected":false},"template":"","categories":[1768,1769],"tags":[1815,1488],"class_list":["post-6892","ec-news","type-ec-news","status-publish","hentry","category-asge-journal-scan","category-asge-kolon","tag-dual-antiplatelet-therapy","tag-kaltschlinge"],"_links":{"self":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news\/6892","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news"}],"about":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/types\/ec-news"}],"wp:attachment":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/media?parent=6892"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/categories?post=6892"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/tags?post=6892"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}