Management of antithrombotic agents for colonoscopic polypectomies in Israeli gastroenterologists relative to published guidelines

Background: Endoscopic procedures are commonly performed in patients taking antithrombotic agents. Objective: To examine the correlation between the management of antithrombotic drugs for colonoscopic polypectomies and the published guidelines. Design and settings: A structured survey delivered to gastroenterologists in 15 major Israeli hospitals and three central HMO clinics. Results: We collected 100 filled out surveys. Polypectomies on aspirin were performed by 78%. Most physicians did not perform polypectomies on clopidogrel. None of the physicians performed polypectomies on warfarin. Cessation of aspirin for ≥. 3. days post-polypectomy was recommended by 60%. Renewal of LMWH or warfarin was recommended ≥. 2. days post-polepectomy in 91% and 71%, respectively. The greatest variation in recommendations was found for clopidogrel, where the majority of gastroenterologists advised renewal after 1-2. days (38%). Years in practice and increasing colonoscopy volume work had no significant association with management of antithrombotic agents. Working in a HMO clinic was associated with lower rates of polypectomies on aspirin (P=0.036). Discussion: When the guidelines are clear, most gastroenterologists practice according to the existing recommendation. However, lack of prospective studies limits the ability to publish evidence-based recommendation and guidelines. We found that the practice of our cohort study varies in these situations.