Impact of continuous antiplatelet therapy versus temporary interruption of antiplatelet therapy on the occurrence of bleeding during colonoscopic polypectomy

Standard care arm Temporary interruption of antiplatelet therapy (clopidogrel or prasugrel or ticagelor): Cessation 7 days prior to colonoscopy and recommencement 2 days after colonoscopy. If a patient is not usually on aspirin, low dose aspirin (75mg - 100mg) orally daily will be commenced to bridge the period the patient is off antiplatelet medication. If a patient is on antiplatelet therapy plus aspirin, patient’s usual dose of aspirin is continued If there are any concerns about temporary interruption of antiplatelet therapy, the endoscopist can liaise with cardiology/neurology to decide whether it is appropriate to temporarily interrupt antiplatelet therapy, or the patient can be excluded from the trial. Polypectomy: Cold snare polypectomy Polyps less than or equal to 10mm Up to 10 polyps during a single colonoscopy Observe polypectomy site If there is any bleeding observe for 2 minutes. At the end of 2 minutes if haemostasis has not occurred, adjunctive therapy in the form of mechanical clips will be used. If polyps larger than 10mm are encountered, management is up to the discretion of the endoscopist with options including a) piecemeal cold snare, b) endoscopic mucosal resection, c) reschedule patient. Intervention arm Continue antiplatelet therapy (clopidogrel or prasugrel or ticagrelor). Polypectomy: Cold snare polypectomy Polyps less than or equal to 10mm Up to 10 polyps during a single colonoscopy Observe polypectomy site If there is any bleeding observe for 2 minutes. At the end of 2 minutes if haemostasis has not occurred, adjunctive therapy in the form of mechanical clips will be used. If polyps larger than 10mm are encountered, management is up to the discretion of the endoscopist with options including a) piecemeal cold snare, b) endoscopic mucosal resection, c) reschedule patient.