When should anti-platelet therapy be stopped before ERCP?

The correct answer is based on the consideration of both the risks associated with bleeding and the need to maintain adequate anticoagulation in patients who are on anti-platelet therapy. For patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), it is generally recommended to stop the anti-platelet therapy about 10 days prior to the procedure.

This duration allows for the majority of the effects of the anti-platelet medication to diminish, thereby reducing the risk of bleeding during the procedure. It balances the risk of thrombosis associated with the discontinuation of anti-platelet therapy, especially in patients with a history of cardiovascular events or those who have had recent stents placed.

While the timing can vary based on the specific anti-platelet agent being used and the patient’s individual risk factors, the standard practice aligns with stopping therapy approximately 10 days prior to ensure patient safety and efficacy of the procedure. This ensures that the risks associated with bleeding do not outweigh the procedural benefits while also minimizing the potential for thrombotic events.