University of Virginia Health System Charlottesville, VA, United States
Katya Swarts, MD1, Benjamin Robey, MD2, Andrew Copland, MD2 1University of Virginia Health System, Charlottesville, VA; 2University of Virginia, Charlottesville, VA
Introduction: A substantial number of patients undergoing elective endoscopic procedures routinely take aspirin for primary and secondary prevention. Prolonged interruptions in aspirin therapy can lead to adverse events including acute coronary syndrome and stroke. Our national gastroenterology guidelines recommend continuing aspirin through endoscopic procedures. However, periprocedural management of aspirin varies widely among patient and referring providers. We hypothesized that patients frequently discontinue aspirin unnecessarily prior to endoscopic procedures, placing them at higher risk for atherothrombotic adverse events.
Methods: Patients undergoing elective endoscopy are provided with an informational handout instructing them to continue their aspirin. At the time of endoscopy, patients were provided an optional survey to determine whether they continued or discontinued their aspirin prior to the procedure. If the aspirin stopped prior to the procedure, follow up questions addressed the reason for discontinuing aspirin.
Results: Of 43 patients taking aspirin included in the survey, 26 (60%) reported stopping aspirin prior to the procedure (Figure 1a). Of the 26 patients that stopped aspirin, 12 (39%) cited the endoscopy instructions. Three (11%) cited physician instructions (GI, PCP, and cardiologist). The remaining written responses were mostly related to concerns about periprocedural bleeding (Figure 1b). Aspirin was stopped in 10 (38%) patients a day prior to the procedure. In 5 (19%) cases, aspirin was stopped for more than 5 days prior to endoscopy (Figure 1c).
Discussion: The majority of patients surveyed discontinued aspirin prior to elective endoscopy and in some cases, therapy was held for 5 or more days prior to procedure. Most patients stopped aspirin due to concern for procedure related bleeding and a written endoscopy handout instructing them to do so. This occurred despite a handout instructing patients to “discuss blood thinners (other than aspirin) with the prescribing doctor” prior to procedure. These findings indicate there are gaps in education about the safety of continuing aspirin throughout endoscopic procedures and the potential risk of aspirin interruption, especially when the indication is for secondary prevention. Improving patient instructions with direct language related to continuing aspirin before and after endoscopy may be one potential avenue for improvement.
Figure: Figure 1: Survey results: (a) Number of patients who stopped aspirin prior to elective endoscopy (b) Reason for stopping aspirin (c) Time of aspirin discontinuation prior to procedure
Disclosures: Katya Swarts indicated no relevant financial relationships. Benjamin Robey indicated no relevant financial relationships. Andrew Copland indicated no relevant financial relationships.
Katya Swarts, MD1, Benjamin Robey, MD2, Andrew Copland, MD2. P1470 - Asking About Aspirin: A Survey of Patient Perception of Periprocedural Aspirin Management, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.