Aspirin and NSAIDs — Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) given alone in standard doses do not appear to increase the risk of significant bleeding after upper endoscopy with biopsy, colonoscopy with biopsy, or biliary sphincterotomy [9-13]. However, data are conflicting regarding whether there is an increased risk of postpolypectomy bleeding in patients taking aspirin and/or NSAIDs. In a preliminary report of a retrospective study of 3191 colonoscopies with polypectomy, patients who received both aspirin and another NSAID had an increased risk of immediate post-polypectomy bleeding compared with those who did not (odds ratio 14) . However, a subsequent study of 1174 patients who underwent polypectomy found no difference in postpolypectomy bleeding rates among those who received aspirin and/or an NSAID and those who did not (3.2 versus 3.0 percent) . While it is unclear if aspirin and/or NSAID increase postpolypectomy bleeding, the combination of aspirin or other NSAIDS with clopidogrel may increase the risk of postpolypectomy bleeding. (See 'P2Y12 platelet receptor blockers' below.)
Aspirin and NSAIDS do not need to be discontinued for endoscopic procedures. However, for patients undergoing high-risk procedures (table 1), some clinicians elect to stop aspirin and NSAIDs five to seven days prior to the procedure, taking into account the underlying indication for the antiplatelet therapy. In addition, if patients are on aspirin combined with another NSAID, it may be prudent to hold the NSAID if possible.