Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Abstract

ACS Acute coronary syndrome ADP Adenosine diphosphate AF Atrial fibrillation APA Antiplatelet agents APTT Activated partial thromboplastin time This article is published simultaneously in the journals Endoscopy and Gut.

Updated guideline on the management of common bile duct stones (CBDS)

“…For patients taking warfarin or antiplatelet treatment, the previous BSG guideline95 has been incorporated into a new BSG and ESGE guideline,96 which includes advice on patients prescribed DOACs. This class of drugs include factor 10a inhibitors (rivaroxaban, apixiban) and the thrombin inhibitor dabigatran.…”

Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps

“…Patients must have provided adequate consent and should be warned of procedure risks such as bleeding, which can be delayed for up to 3 weeks postprocedure, and of the need for surgery should an intraperitoneal perfor ation occur that cannot be managed with endoscopic clips. Patients should stop taking anticoagulants before EMR or ESD, with appropriate heparin cover for those at increased risk of thromboembolism [29][30][31] . Little evi dence exists that lowdose aspirin (75 mg) adversely affects bleeding risk, and continuing to take this drug might be important to reduce the risk of cardiac events in those with marked cardiovascular disease 32 .…”

“…Little evi dence exists that lowdose aspirin (75 mg) adversely affects bleeding risk, and continuing to take this drug might be important to reduce the risk of cardiac events in those with marked cardiovascular disease 32 . However, clopidogrel and other potent antiplatelet agents should be stopped for at least 5 days before either procedure 31 . Most EMR resections can be performed under conscious sedation, although procedures that are anticipated to take a long time (ESD, very large PEMR) or resections close to the dentate line might be more comfortably per formed with propofol deep sedation or general anaesthe sia.…”

Restoration of Antithrombotic Therapy in Ibs Patients After Episode of Bleeding

“…При рассмотрении проблемы возобновления АТТ после кровопотери следует выделить вопросы терапии при кровотечении из ЖКТ и кровотечении у больных ИБС, имеющих фибрилляцию предсердий, на фоне приема антикоагулянтов [16]. Желудочно-кишечные кровотече-ния (ЖКК) -частое осложнение, наблюдаемое у больных ИБС, получающих АТТ, поскольку один из основных анти-агрегантов -АСК обладает проульцерогенным эффектом.…”

“…Угроза возникновения кровопотерь возникает при выполнении некоторых дополнительных манипуляций: полипэктомии, дилатации стриктур и про-цедуры стентирования ЖКТ, лечении варикоза пищевода, при эндоскопических хирургических вмешательствах, в случае диссекции слизистой [16]. Добавление в терапию ингибиторов протонных помп рекомендуется во всех случаях состоявшихся кровотечений из верхних отделов ЖКТ, а также профилактически при их высоком риске.…”