Colonoscopy and Antiplatelet Therapy Trial

Inclusion criteria

• Age ≥ 45 years
• Stable patients defined as having Angina CCS (Canadian Cardiovascular Society) class 1-3 and/or Heart Failure NYHA class 1-2 without a change in guideline directed anti-ischemic or heart failure medications within 30 days prior to randomization.
• Patients with cardiovascular disease defined as coronary artery disease, cerebrovascular disease or peripheral vascular disease taking DAPT (defined as aspirin plus a P2Y12 inhibitor). The decision to use DAPT in this patient will be made by the managing physician(s) before recruitment for this study. Consider replacing last statement with "As directed by their physician prior to recruitment into this study"
• Scheduled for elective screening or surveillance outpatient colonoscopy

Exclusion criteria

• Coronary intervention (PCI or CABG) less than 90 days prior to randomization
• ACS event in less than 90 days prior to randomization
• Transient ischemic attack (TIA) and/or stroke event in less than 90 days prior to randomization
• Acute limb ischemia and/or amputation in less than 90 days prior to randomization
• Post cardiac valve replacement (either percutaneous or surgical)
• High cardiovascular risk:

• Patients with CCS class 4 angina
• Hospitalized with ACS within 1 month prior to randomization
• Patients undergoing PCI or CABG within the 3 months prior to randomization
• Patients on left ventricular assist device (LVAD) or post cardiac transplantation
• Patients with NYHA class 3 or 4 heart failure
• Any condition requiring treatment requires chronic use of an anticoagulant.
• Chronic kidney disease Stage 5 (with or without dialysis)
• Liver cirrhosis with platelet count < 50,000/ mm3 and/or INR >1.4
• Hematocrit < 30% and hemoglobin < 10 mg/dL
• Emergent or inpatient Colonoscopy