Continue or Discontinue Dual Antiplatelet Therapy in Major Surgical or Endoscopic Procedures

mandatory after acute coronary syndrome or stent implantation because coronary lesions and stents behave like unstable plaques as long as they are not fully covered by a cellular layer. Current guidelines recommend that elective, noncardiac surgery should be postponed for at least 6 weeks after the placement of bare-metal stents and for at least 12 months after the placement of drug-eluting stents.1 The question remains whether to continue or discontinue antiplatelet therapy and face the risk of either perioperative bleeding or adverse cardiac events, especially in urgent situations. With this question in mind, Abdel Samie et al.2 reported a small case series of 11 consecutive patients who underwent biliary-pancreatic surgery or endoscopic intervention while receiving dual antiplatelet therapy. In this retrospective study, neither immediate nor clinically significant delayed bleeding was reported in patients with endoscopic sphincterotomy (n=9) and major surgery (n=2). Although this study has only a limited number of patients, its results suggest that even major surgical and endoscopic procedures can be performed safely in patients who continue dual antiplatelet therapy. Although there is a lack of randomized controlled trials comparing the effects of withdrawing versus continuing antiplatelet agents in the perioperative period, it appears that the average relative increase in bleeding during noncardiac surgery is 20% with aspirin or clopidogrel alone.3,4 Recently, Chernoguz Clin Endosc 2013;46:315-316