Management of Anticoagulation and Colonoscopy.

Purpose of review: Patients undergoing colonoscopy frequently require antithrombotic therapy for underlying cardiovascular disease. Antithrombotic therapy increases the risk of bleeding during or after colonoscopy, particularly when more invasive procedures are required. However, the risk of thrombosis—with possibly devastating consequences—is increased if antithrombotic agents are held. This review will highlight existing data on the balance of procedural and patient risk factors to guide endoscopists on the management of periprocedural antithrombotic therapy. Recent findings: Diagnostic colonoscopy has long been established to be low risk for hemorrhage even in patients on antithrombotic therapy, while colonoscopy with interventions—including polypectomy—is viewed as high risk requiring interruption of antithrombotic therapy when possible. Recent data, however, has challenged these practices and suggests that a more nuanced perspective may be necessary. For example, a recent randomly controlled trial found no difference in immediate or delayed hemorrhage between patients on dual antiplatelet therapy versus aspirin and placebo after polypectomy. Further, increasing data are emerging to suggest that small polypectomy (< 1 cm) is safe without interruption of anticoagulation with the use of cold snare polypectomy. Summary: In patients undergoing colonoscopy, the risk of hemorrhage must be weighed against the risk of thrombosis in patients with cardiovascular disease on antithrombotic agents. In general, low-risk procedures do not require interruption of antithrombotic agents, while high-risk procedures in low-risk patients require holding antithrombotic therapy. High-risk procedures in high-risk patients require individualized decision-making with increasing data helping to support which procedures can safely be performed. [ABSTRACT FROM AUTHOR]