MKSAP Quiz: Aspirin management before polypectomy
A 58-year-old man is counseled before undergoing colonoscopy and polypectomy in 10 days' time. Two years earlier, he had an inferior wall myocardial infarction. His medications are low-dose aspirin, atorvastatin, metoprolol, and enalapril. What is the most appropriate management of his aspirin therapy?
A 58-year-old man is counseled before undergoing colonoscopy and polypectomy in 10 days' time. A routine screening CT colonography showed two polyps in the descending colon, 10 mm and 8 mm in size. Two years earlier, he had an inferior wall myocardial infarction. His medications are low-dose aspirin, atorvastatin, metoprolol, and enalapril.
Which of the following is the most appropriate management of his aspirin therapy?
A. Continue aspirin use until the day of the polypectomy; resume in 48 hours
B. Discontinue aspirin use 7 days before the polypectomy; resume immediately after
C. Discontinue aspirin use 7 days before the polypectomy; resume in 48 hours
D. Do not discontinue aspirin
MKSAP Answer and Critique
The correct answer is D. Do not discontinue aspirin. This content is available to MKSAP 18 subscribers as Question 3 in the Gastroenterology and Hepatology section. More information about MKSAP is available online.
This patient should not discontinue aspirin use. Aspirin does not need to be discontinued before colonoscopy in any scenario, and data from studies of patients who have undergone polypectomy show no difference in the risk for postprocedure bleeding with discontinuation or continuation of aspirin use. The American College of Gastroenterology's 2016 guidelines for management of lower gastrointestinal bleeding (LGIB) recommend the continuation of aspirin for secondary cardiovascular prophylaxis after polypectomy. Discontinuing aspirin is recommended after polypectomy in patients without established cardiovascular disease who are using aspirin as primary prophylaxis. In patients with established cardiovascular disease, such as this patient, the risks of a potential cardiovascular event outweigh those of potential gastrointestinal bleeding.
Holding aspirin for a period of time after a polypectomy, such as 48 hours, has not been shown to reduce postprocedure LGIB and may increase risk for a thromboembolic event in a patient with established cardiovascular disease.
Key Point
- Aspirin for secondary prophylaxis in patients with established cardiovascular disease should be continued after colonoscopy with polypectomy.