Management of Ozempic and Plavix Before Colonoscopy
Plavix (Clopidogrel) Management
For colonoscopy with potential polypectomy, discontinue clopidogrel 7 days before the procedure to minimize bleeding risk, but only after assessing thrombotic risk and consulting with the prescribing cardiologist if the patient has high-risk cardiovascular conditions. 1, 2
Risk Stratification for Clopidogrel Management
Low Thrombotic Risk Patients:
- Discontinue clopidogrel 7 days before colonoscopy if polypectomy is anticipated 1, 2
- For diagnostic colonoscopy without polypectomy or biopsy only, clopidogrel can be continued without interruption 2
- Resume clopidogrel 1-2 days after the procedure if no bleeding complications occur 1, 2
High Thrombotic Risk Patients (requires cardiology consultation):
- Drug-eluting coronary stent placed within 6-12 months 1, 2
- Bare metal stent placed within the last month 1, 2
- Recent acute coronary syndrome 2
- History of ischemic heart disease, cerebrovascular disease, or peripheral vascular disease 1
Management Options for High-Risk Patients
If polypectomy is needed in high-risk patients, consider these approaches:
- Defer elective colonoscopy until it is safer to interrupt clopidogrel (preferred option) 2
- For small polyps (<1 cm), use cold snare polypectomy technique while continuing clopidogrel 2
- Continue aspirin if patient is on dual antiplatelet therapy and only stop clopidogrel 1
- Never stop clopidogrel without consulting the prescribing cardiologist 2
Evidence on Bleeding Risk
The data clearly demonstrates increased bleeding risk with continued clopidogrel:
- Meta-analysis shows a risk ratio of 1.96 (95% CI 1.36-2.83) for post-polypectomy bleeding with continued clopidogrel 2, 3
- Delayed bleeding risk is significantly elevated (RR 3.10-4.66) compared to immediate bleeding 3, 4
- However, one randomized trial showed no statistically significant difference in delayed bleeding (3.8% vs 3.6%), though the trend favored stopping clopidogrel 5
Critical Pitfalls to Avoid
- Do not bridge with heparin for clopidogrel cessation - this is not recommended and may increase bleeding risk 2
- Advise all patients on clopidogrel of increased post-procedure hemorrhage risk compared to those not on antiplatelet therapy 1
Ozempic (Semaglutide) Management
There are no specific guidelines addressing GLP-1 agonists like Ozempic in the provided colonoscopy preparation evidence. However, based on general medical knowledge and bowel preparation principles:
Practical Recommendations for Ozempic
- Continue Ozempic on its regular schedule - there is no established need to hold GLP-1 agonists before colonoscopy
- Be aware that GLP-1 agonists can delay gastric emptying, which theoretically could affect bowel preparation quality
- Ensure patients complete their bowel preparation as directed, with the second dose beginning 4-6 hours before colonoscopy and completed at least 2 hours before the procedure 1
Bowel Preparation Timing (applies to all patients)
Use split-dose bowel preparation for optimal results:
- The second portion should begin 4-6 hours before colonoscopy 1
- Complete bowel preparation at least 2 hours before the procedure start 1
- For afternoon colonoscopies, same-day dosing is an acceptable alternative 1
- Target adequate preparation rate should be at least 85%, ideally >90% 6
Post-Procedure Management
Resume clopidogrel 1-2 days after colonoscopy if no bleeding complications occur, depending on perceived hemorrhagic and thrombotic risks 1, 2