From the Guidelines
Aspirin can generally be continued before endoscopy for most patients, as the risks of thrombosis often outweigh the bleeding risks, especially for those taking aspirin for secondary prevention. For diagnostic endoscopic procedures, including upper endoscopy and colonoscopy (even with biopsies), aspirin does not need to be discontinued as the bleeding risk is minimal 1.
Considerations for Therapeutic Procedures
For therapeutic procedures with higher bleeding risk, such as polypectomy of large polyps (>2cm), endoscopic mucosal resection, or endoscopic submucosal dissection, temporary aspirin discontinuation may be considered on a case-by-case basis, typically 5-7 days before the procedure. However, the decision to discontinue aspirin should be made with caution, considering the patient's specific cardiovascular risk factors and the type of endoscopic procedure planned 1.
Secondary Prevention Considerations
For patients taking aspirin for secondary prevention (those with history of heart attack, stroke, or stent placement), the cardiovascular risks of stopping aspirin often outweigh the bleeding risks, so aspirin should usually be continued even for higher-risk procedures 1. The risks of thrombosis versus haemorrhage need to be assessed on an individual patient basis, and consultation between the gastroenterologist and the physician who prescribed the aspirin is recommended 1.
Resuming Aspirin After Procedure
After any procedure, aspirin can typically be resumed within 24-72 hours depending on whether any therapeutic intervention was performed. It is essential to weigh the benefits of resuming aspirin against the potential bleeding risks associated with the procedure 1.
Key Points to Consider
- Aspirin can be continued for most diagnostic endoscopic procedures.
- For therapeutic procedures with higher bleeding risk, temporary aspirin discontinuation may be considered on a case-by-case basis.
- Patients taking aspirin for secondary prevention should usually continue aspirin, even for higher-risk procedures, due to the high cardiovascular risks associated with stopping aspirin.
- The decision to discontinue or continue aspirin should be individualized and based on consultation between healthcare providers.
From the Research
Aspirin and Endoscopy
- The decision to stop aspirin before endoscopy is a topic of discussion, with some studies suggesting that it may not be necessary to discontinue aspirin therapy prior to outpatient endoscopic procedures 2.
- A study published in 2020 found that many patients inappropriately alter their aspirin therapy before endoscopy, despite guidelines recommending continuation of aspirin therapy to reduce peri-procedural cardiovascular events and minimize bleeding risk 2.
- Another study published in 2011 found that gastroduodenal biopsy is safe in patients receiving aspirin and clopidogrel, with a low risk of bleeding attributable to the biopsy procedure itself 3.
Bleeding Risk and Aspirin
- A systematic review and meta-analysis published in 2022 found no significant difference in post-ERCP bleeding rates between dual antiplatelet agents and aspirin alone, suggesting that the risk of bleeding may be more related to the procedure itself rather than the antiplatelet agents used 4.
- A study published in 2012 discussed the pharmacology and clinical applications of aspirin, highlighting its role in reducing the risk of cardiovascular disease and its continued use as a major antiplatelet agent despite the development of newer therapies 5.
- The use of aspirin in patients undergoing endoscopy is supported by guidelines, which recommend continuation of aspirin therapy to minimize bleeding risk and reduce peri-procedural cardiovascular events 2, 3.
Clinical Implications
- Patients should be educated on the importance of continuing aspirin therapy prior to outpatient endoscopy, unless otherwise instructed by their healthcare provider 2.
- Healthcare providers should be aware of the guidelines and evidence supporting the continuation of aspirin therapy in patients undergoing endoscopy, and should educate their patients accordingly 2, 3, 4.