Risk of endoscopic procedure haemorrhage | Risk of thrombosis | |||
---|---|---|---|---|
Low risk | High risk | Low risk | High risk | |
Aspirin | ||||
Continue | Biopsy 0%84 | Standard risk of procedure, except large colonic EMR 6.2–7%32 33 with ‘recent’ LDA. Gastric ESD increased risk on LDA to 21.1%29 vs no increased risk 15.5%124 | 0.51% per year%203 | 1.8% at 30 days36 |
Discontinue 7 days | N/A | Standard risk of procedure | Estimate <1% per year | 9% at 30 days36 |
Warfarin | ||||
Continue | Biopsy 0%84 | Polypectomy 0.8–23%6 7 | <1% per year204 | 1% per year205 |
Discontinue 5 days | N/A | Standard risk of procedure; increased PPB risk15 | AF 0.4% at 30 days17 | N/A |
Bridge with LMWH | N/A | Standard risk of procedure; increased PPB risk15 | AF 0.3% at 30 days17 | Metal heart valves 0%22 23 |
Dual APA | ||||
Continue | Biopsy 0%84 85 | Polypectomy <1 cm 2.1–6.45%120 121 | N/A | 1.3% at 9 months47 |
Discontinue 5 days | N/A | Estimate standard risk of procedure | N/A | Not advised |
DOAC | ||||
Omit day of procedure | No specific data | N/A | No specific data | DOAC not indicated |
Discontinue 48 h | N/A | No specific data | 0.8%72 | DOAC not indicated |
Key references in superscript.
AF, atrial fibrillation; APA, antiplatelet agent; DOAC, direct oral anticoagulant; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; LDA, low-dose aspirin; LMWH, low molecular weight heparin; N/A, not applicable; PPB, post-polypectomy bleeding.