October 15th, 2010
Plavix (Clopidogrel) and endoscopy: the great dilemma!
Plavix and other platelet inhibitors have saved countless lives by preventing cardiovascular events. But those same inhibitory effects on platelets theoretically could increase bleeding risks after GI procedures that include biopsy or tissue removal (polypectomy).
Unfortunately there are little data regarding whether bleeding risk is increased when patients on Plavix undergo endoscopy procedures. The clinical choices are either to stop the Plavix and maybe decrease the risk of bleeding post procedure but also maybe increase the patient’s risk for a cardiovascular complication or continue the Plavix and possibly increase the risk of GI bleeding but protect their heart and brain!
What a dilemma and little of no data to guide us. So what do you do: stop Plavix or perform the procedure on the drug? Let us know how you are dealing with this difficult dilemma.
7 Responses to “Plavix (Clopidogrel) and endoscopy: the great dilemma!”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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CONSULT with cardiologist to reassess the risk of stopping Plavix.
or Go for an only diagnostic optical colonoscopy as a first step
or Go for a CT colonoscopy if it is only for screening
perform the procedure on the drug ,because the heart and brain are vital ograns ,and we can replace the blood that lost .thax
I have been taking plavix for three years, i recently had my first colonoscopy with polyp removal. i had stopped the plavix 7 days before proceedure and started the plavix the day after, well 5 days later i had a serious bleeding event, ended up 2 days in intesive care 5 days in hospital, needed 2 bags of platelets and 3 units of blood, seemed like a serious situation to me,
i wonder what is the recommendation in this situation.
thanks
jan
I stop Plavix if stenting is more than 3 months old but maintain or start aspirin. Plavix is resumed 7 days later. This precaution is for polypectomy or sphincterotomy and esophageal dilation. If faced with a patient who I have only seen on the day of a endoscopy, I discuss the risks of combined aspirin and Plavix and may proceed with a gentle esophageal dilation or the removal of a small polyp.
Dr. Parent,
A little more help please, the doctor that did my polypectomy gave me verbal and written instructions to start plavix the next day. you are the second doctor to tell me I should have waited for 7 days, ist there some reference I can give this doctor for future.
Thanks
Jan
Depends on the patient. If stenting was made less than 3 months, or the patient had recent MI or other cardiovascular complication requiring clopidogrel there is a certain risk on stoping tthe drug. I think the doctor and the patient should always discuss about this topic (pros and cons) before the procedure. There is a special rule when evidence is lacking: discuss with the patient!!!
I have a kidney stone between on the ureter. I had a stent on my Ureter put in last week to save the kidney which was blocked.
I am on Plavix for the last 8 months, as a stent was put somewhere in the heart, and aspiring 325mg for the last 10 years.
The kidney stone is still there and my next appointment is in a week to discuss which procedure will be used for the stoned removal. The Urologist advised that I have to discontinue plavix and aspiring 5 days before the procedure.
My dilemma is that if I discontinue the plavix and aspiring there is a risk of a trombosis. If I don’t the bleeding could be too much..
I guess I could die from one or the other.
Any advise?