Document Detail

Antiplatelet therapy and the risk of bleeding induced by gastrointestinal endoscopic procedures. A systematic review of the literature and recommendations.
MedLine Citation:
PMID:  17429206     Owner:  NLM     Status:  MEDLINE    
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.
N A Kimchi; E Broide; E Scapa; S Birkenfeld
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Publication Detail:
Type:  Journal Article; Review     Date:  2007-04-10
Journal Detail:
Title:  Digestion     Volume:  75     ISSN:  1421-9867     ISO Abbreviation:  Digestion     Publication Date:  2007  
Date Detail:
Created Date:  2007-05-09     Completed Date:  2007-05-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0150472     Medline TA:  Digestion     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  36-45     Citation Subset:  IM    
Copyright Information:
Copyright 2007 S. Karger AG, Basel.
Institute of Gastroenterology, Liver Diseases and Nutrition, Assaf Harofeh Medical Center, Zerifin, Israel.
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MeSH Terms
Aspirin / adverse effects*
Biopsy, Needle / adverse effects
Bleeding Time
Endoscopy, Gastrointestinal / adverse effects*
Gastrointestinal Hemorrhage / chemically induced,  etiology*
Intestinal Polyps / diagnosis,  surgery*
Platelet Aggregation Inhibitors / adverse effects*
Risk Factors
Sphincterotomy, Endoscopic / adverse effects
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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