Periprocedural management of aspirin during colonoscopy: a survey of practice patterns in the United States

BackgroundThe risk of postpolypectomy bleeding for patients taking aspirin is low, and gastroenterology society guidelines state that aspirin is likely safe to continue; however, many practices recommend aspirin discontinuation.ObjectiveTo characterize practice patterns of periprocedural aspirin use with colonoscopy in the United States.DesignSurvey study.SettingEndoscopy units in the United States.InterventionsWe reviewed colonoscopy preparation instruction sheets available online to characterize recommendations regarding periprocedural aspirin use. The endoscopy units that recommended discontinuation of aspirin before colonoscopy were contacted to determine their reasons for doing so. We also determined which endoscopy units were recognized by the American Society for Gastrointestinal Endoscopy (ASGE) quality recognition program.Main Outcome MeasurementsEndoscopy unit recommendations regarding aspirin use before colonoscopy.ResultsWe reviewed colonoscopy preparation instructions from 317 endoscopy units, of which 138 (43.5%) recommended continuing aspirin, 103 (32.5%) recommended stopping aspirin, and 76 (24%) requested patients to contact a physician. The most common reasons for recommending aspirin discontinuation were concern about bleeding after polypectomy (62%), perceived minimal downside to stopping aspirin (38%), inertia to changing old policies (20%), and concern about medicolegal implications of postpolypectomy bleeding (15%). There was no significant association between endoscopy unit recommendations about periprocedural aspirin use and ASGE quality certification (P = .17) or type of endoscopy facility (ambulatory surgical center vs hospital affiliated) (P = .55).LimitationNon-response bias.ConclusionLess than half of the endoscopy units surveyed in the United States routinely continue aspirin before screening colonoscopies despite evidence that benefits outweigh the risks. It is important for gastroenterology and cardiology societies to make a firm statement, educate their members, and give them confidence and support to continue aspirin periprocedurally.