CLINICIAN INSTRUCTIONS ON MANAGEMENT OF ANTITHROMBOTICS BEFORE COLONOSCOPY: A RETROSPECTIVE ANALYSIS OF 4,777 PATIENTS IN ONE YEAR COHORT

The use of antithrombotics (antiplatelet agents and anticoagulants) is increasing with an aging global population. Although there are international practice guidelines on the management of antithrombotics in patients undergoing endoscopy, adherence to these recommendations is unknown. This is a retrospective analysis of patients undergoing colonoscopy from July 2015 to June 2016 in a teaching hospital. Patients were selected if they were receiving antithrombotics when colonoscopy was scheduled and were expected to require long-term treatment after colonoscopy. We reviewed the in-patient and out-patient consultation notes starting from the date of arranging colonoscopy until the procedure day. The stoppage and reversal instructions of antithrombotics were assessed. Provision of the instruction was considered present if one or more of following wordings or their abbreviated forms were documented in the consultation notes: withhold, stop, off, resume, restart, reversal, put on and continue. Between July 1, 2015 and June 30, 2016, 4,777 patients underwent colonoscopy, 529 patients (male: 62.1%; mean age: 70.6) used antithrombotics (405 aspirin users, 10 thienopyridine users, 114 anticoagulant users). Among them, 79 (14.9%) patients had received the instructions (6/405, 1.5% in aspirin users; 6/10, 60.0% in thienopyridine users; 67/114, 58.8% in anticoagulant users) (Figure 1). All instructions were found at the time of arranging colonoscopy but not in other subsequent consultation notes. Although professional societies have provided guidance on the management of antithrombotics in patients undergoing colonoscopy, less than 15% of clinicians documented their peri-endoscopy instructions in consultation notes. Future prospective studies are needed to understand the barriers to poor clinician adherence and their impact on clinical outcomes.