FRIDAY, Dec. 4 (HealthDay News) -- In patients with coronary artery disease who need an elective endoscopic gastrointestinal procedure with a high risk of bleeding, cessation of antiplatelet treatment should be avoided for at least six months after undergoing revascularization and stent placement, according to a review in the Dec. 8 issue of the Journal of the American College of Cardiology.

Richard C. Becker, M.D., of Duke University Medical Center in Durham, N.C., and colleagues reviewed the periprocedural management of patients with atherosclerotic coronary heart disease who may have to temporarily discontinue antiplatelet treatment before an elective endoscopic gastrointestinal procedure.

The researchers recommend that antiplatelet therapies should be continued after percutaneous coronary intervention (PCI) with stent placement when possible, and that clopidogrel should be continued within the first 30 days, even if aspirin is already being continued. If possible, endoscopic procedures should be deferred up to 12 months after PCI with drug-eluting stents. Endoscopic procedures associated with a high risk of bleeding should be performed five to seven days after thienopyridine drug cessation, while aspirin should be continued if possible, and drugs should be resumed after the procedure once hemostasis is achieved. For procedures associated with a low risk of bleeding, platelet-directed therapy should be continued.

"The potential for complications associated with high-risk endoscopic procedures can be reduced by avoiding excessive tissue injury during the procedure, sound technical skills, and good clinical judgment," the authors write.

Several authors reported financial, advisory or consulting relationships with pharmaceutical companies.

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