Management of Antiplatelet Therapy Before Colonoscopy

Risk Stratification and Medication Management

For patients undergoing high-risk colonoscopy procedures, such as polypectomy, the American College of Gastroenterology recommends discontinuing Plavix 5 days before the procedure while continuing aspirin, unless the patient has high thrombotic risk requiring cardiology consultation 1, 2
The American College of Gastroenterology suggests that low-risk procedures, such as diagnostic colonoscopy with biopsies only, do not require medication adjustments, and both aspirin and Plavix can be continued without interruption 1, 2, 3
For high-risk procedures, the American Heart Association recommends assessing thrombotic risk, with low thrombotic risk patients including those with ischemic heart disease without coronary stents, cerebrovascular disease, peripheral vascular disease, or more than 3 months after venous thromboembolism 2, 5
The American College of Cardiology recommends that high thrombotic risk patients, including those with drug-eluting stents placed within 12 months, bare metal stents placed within 1 month, acute coronary syndrome or PCI within 6 months, or prosthetic metal heart valve in mitral position, should continue aspirin and liaise with cardiology regarding the risk/benefit of discontinuing Plavix 3, 5, 6

For low thrombotic risk patients on dual antiplatelet therapy, the American College of Gastroenterology recommends stopping Plavix 5 days before colonoscopy and continuing aspirin throughout the periprocedural period 1, 2, 4
For high thrombotic risk patients on dual antiplatelet therapy, the American Heart Association recommends continuing aspirin and liaising with cardiology immediately regarding the risk/benefit of discontinuing Plavix 1, 5, 7

The American College of Gastroenterology warns against stopping both antiplatelet agents simultaneously, as this dramatically increases stent thrombosis risk, with a median time to thrombosis as short as 7 days 6
The American College of Cardiology advises against holding Plavix for longer than necessary, as the total duration of interruption should not exceed 7 days, and each additional day off therapy increases cardiovascular event risk 6, 7

For patients on aspirin monotherapy, the American College of Gastroenterology recommends continuing aspirin for both diagnostic and therapeutic colonoscopy, as postpolypectomy bleeding risk with continued aspirin is low and manageable 1, 2, 7