Management of antithrombotic therapy prior to colonoscopy: experience in a secondary-level hospital

Aims Performing endoscopic studies in patients under antithrombotic therapy can pose a clinical challenge due to the potential risk of bleeding. The decision to continue, suspend, or substitute this type of treatment is a topic of debate in clinical practice, with significant variability in the management strategies adopted.

The primary objective of our study was to evaluate the appropriateness of discontinuing or substituting antithrombotic therapy. Secondary objectives included assessing variability based on the referring specialist and analyzing the incidence of severe bleeding and thrombotic complications.

Methods A descriptive observational study was conducted, retrospectively collecting data on patients who underwent colonoscopy under antithrombotic therapy in a secondary-level hospital from January to December 2023.

Results Out of the 1,735 colonoscopies performed at our center in 2023, 410 were on patients receiving antithrombotic therapy. The majority (66.6%) were men, with a mean age of 71±10.9 years. The main reason for the request was the follow-up of polyps (28.8%). Antiplatelet therapy was used by 58.8% of patients, primarily with acetylsalicylic acid (43.9%), and 44.6% were on anticoagulant therapy, mainly with new oral anticoagulants (38%).

In 28% of cases, discontinuation or substitution of therapy was inappropriate, either because treatment was not withdrawn when indicated or due to substitution with heparin without indication. The procedure had to be repeated in 7 patients who required high-risk therapeutic interventions. Five individuals experienced severe bleeding, all undergoing high-risk therapeutic procedures, despite appropriate adjustment of therapy. There were no cases of thrombosis.

Conclusions Managing antithrombotic therapy before colonoscopy is crucial to prevent hemorrhagic complications without increasing thrombotic risk. Although there were cases of inappropriate management, the need to repeat the procedure and associated clinical complications were minimal. Interdisciplinary collaboration is essential to improve the safety of these patients.

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Artikel online veröffentlicht:
27. März 2025