Tu1249 Wide Variations in Practice Patterns Regarding Management of Anti-Platelet Agents During Endoscopy: Resuts From a Nation-Wide Survey

Wide Variations in Practice Patterns Regarding Management of Anti-Platelet Agents During Endoscopy: Resuts From a NationWide Survey Sravanthi Parasa*, Preetika Sinh, Mandeep Singh, Vijay Kanakadandi, Maria Giacchino, Neil Gupta, Srinivas Gaddam, Amit Rastogi, Ajay Bansal, John L. Petrini, Prateek Sharma Gastroenterology, The University of Kansas Medical Center, Kansas City, KS; Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, MO; Internal Medicine, The University of Kansas Medical Center, Kansas City, KS; Gastroenterology, Loyola University Medical Center, Chicago, IL; Gastroenterology, Washington University School of Medicine, St Louis, MO; Gastroenterology, Sansum Clinic, Santa Barbara, CA Background: ASGE has established guidelines for the management of antiplatelet agents during endoscopy. However there are limited data on practice patterns of gastroenterologists regarding withholding antiplatelet agents prior to any gastrointestinal procedure. Aim: To evaluate adherence of community gastroenterologist to ASGE guidelines with regards to withholding antiplatelets for endoscopic procedures and to evaluate for factors that influence the gastroenterologist’s decision. Methods: Community gastroenterologists were asked to complete a survey (during 2 major national GI conference) on the type of antiplatelet agents, type of procedure, factors affecting the decision to hold the antiplatelet agents and the duration for which they were held was obtained. Information regarding time to restarting the antiplatelet agents was also obtained. Data from completed surveys were entered and analyzed using STATA 12.0. ANOVA and Mantel-Haenszel chi-square tests were done to test for statistical significance when comparing the various subcategories. Results: Of a total of 400 attendees, 239 (59.7%) physicians completed the survey. Sixty (26%) physicians held all antiplatelet agents (including ASA, NSAIDs, clopidrogel) prior to all endoscopic procedures, and among these physicians there were differences in the duration of withholding these agents based on the type of agent used. The decision to withhold antiplatelet agents was independent of the mean number of procedures performed, patient factors, or the knowledge of ASGE guidelines. However, physician‘s own previous experience with anti-platelet agentswas a significant factor for withholding all agents prior to any procedure [30.5 % vs 13.1 % (p 0.003)]. Most physicians restarted antiplatelet agents after 3-5 days for endoscopic polypectomy (57.6% vs 28.8 % (1-3 days) vs 11.9% (same day), p 0. 001) and ERCP with sphincterotomy (49.2%, vs 22% (1-3 days) vs 6% (same day) p 0.002) and 1-3 days for Esophageal dilation (45.8% vs 32.2% (3-5 days) vs 22% (same day), p 0.001) and same day for endoscopic biopsy (54.2% vs 32.2%(1-3 days) vs 8.5% (3-5 days), p .001) Conclusions: More than a 25% of gastroenterologists withhold all anti-platelet agents prior to any GI procedure a decision based on their own prior experience. There appears to be poor penetration of ASGE guidelines among gastroenterologists in regard to the use of antiplatelet agents prior to endoscopic procedures. Focused education and quality measure may improve this practice.