J Cancer Clin | Volume 2, Issue 1 | Research Article | Open Access

Management of Antithrombotic Agents during Elective Colonoscopic Procedures

Paluru MMR*, Kaushik M, Bhullar J and Mittal VK

Department of Surgery, Ascension Providence Hospital, USA

*Correspondance to: Madan Mohan R Paluru 

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Background: Management of antithrombotics (anticoagulant and antiplatelet) before and after the
endoscopic procedures requires consideration. There is availability of limited prospective data on
this issue in the literature. The guidelines formulated are based on expert opinion, thus encountered
as a common clinical problem routinely in clinical practice. In view of changing reports in literature
subsequent to the previously published guidelines we reviewed the literature (2010-2022) to update
on latest practices in this field.
Materials and Methods: The methodology involved a search of the literature on PubMed for
articles published during the past 12-year period (2010-2022) using the terms ‘antiplatelet agents’,
‘anticoagulants’ or ‘NSAIDs’ and were matched with the term’s ‘endoscopy’, ‘polypectomy’ and
‘colonoscopy’. More specific searches were conducted using the keywords ‘clopidogrel’, ‘aspirin’,
‘warfarin’, ‘heparin ‘and ‘low molecular weight heparin’, as well as the generic names of other
antiplatelet agents and low molecular weight heparins such as ‘lovenox’, ‘xeralto’, ‘eliquis’ currently
available in the US, were also matched with three procedural terms noted above on 09/30/2022.
Only articles published in the English literature were included in this review.
Results: A MEDLINE PubMed search on 09/30/2022 limited to studies available in English revealed
2,644 peer-reviewed articles on "endoscopy with anticoagulants". The search was narrowed to 539
peer-reviewed articles on specifying colonoscopic procedures. Out of 539 articles 379 were published
in the past twelve years. Of the articles in the search, each subtopic related to antithrombotic
(antiplatelet and anticoagulants) use during colonoscopic procedures was separately scrutinized
and analyzed.
Conclusion: Management of patients on antithrombotics remains complex. Existing guidelines are
valuable but should not be a substitute for a careful personalized risk assessment strategy involving
patient and physician.


Keywords: Anticoagulant; Antiplatelet; Colonoscopy; Polypectomy; Warfarin; Aspirin; Clopidogrel; Low molecular weight heparin; Nsaids; Heparin; EMR; Lovenox; Xarelto; Eliquis


Paluru MMR, Kaushik M, Bhullar J, Mittal VK. Management of Antithrombotic Agents during Elective Colonoscopic Procedures. J Cancer Clin. 2022; 2(1): 1009..

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