Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy

Abstract

agents, including antiplatelet agents and anticoagulants, are increasingly used in South Korea. The management of patients using antithrombotic agents and requiring gastrointestinal endoscopy is an important clinical challenge. Although clinical practice guidelines (CPGs) for the management of patients receiving antithrombotic agents and undergoing gastrointestinal endoscopy have been developed in the Unites States, Europe, and Asia Pacific region, it is uncertain whether these guidelines can be adopted in South Korea. After reviewing current CPGs, we identified unmet needs and recognized significant discrepancies in the clinical practice among regions. This is the first CPG in Korea providing information that may assist endoscopists in the management of patients on antithrombotic agents who require diagnostic or elective therapeutic endoscopy. This guideline was developed through the adaptation process as an evidence-based method, with four guidelines retrieved by systematic review. Eligible guidelines were evaluated according to the Appraisal of Guidelines for Research and Evaluation II process, and 13 statements were established using a grading system. This guideline was reviewed by external experts before an official. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

Utility of a deep learning model and a clinical model for predicting bleeding after endoscopic submucosal dissection in patients with early gastric cancer

“…The expert assesses the thromboembolic risk depending on the underlying disease and recommends the possibility of interruption, duration of interruption, and the need for heparin bridging or replacement of APA[ 33 - 36 ]. Recently, a guideline published in South Korea also categorized ESD as an ultra-high-risk procedure and recommended interruption of ATs with heparin bridging or replacement of APA according to the thromboembolic risk[ 37 ].…”

Predicting the Bleeding Risk for Patients on Anticoagulant Therapy Prior to Gastric Endoscopic Submucosal Dissection

“…The joint Asian Pacific Association of Gastroenterology and Asian Pacific Society for Digestive Endoscopy practice guidelines state that, among therapeutic endoscopic procedures, ESD has a particularly high risk of bleeding [ 1 ]. The number of patients on antithrombotic therapy, including antiplatelet or anticoagulant agents, has been reported to have increased [ 2 3 ], with antithrombotic agents further increasing the risk of bleeding during ESD. Thus, the timing of antithrombotic therapy discontinuation prior to ESD is important for patients after having considered the risks of bleeding and thromboembolic events.…”

“…Thus, the timing of antithrombotic therapy discontinuation prior to ESD is important for patients after having considered the risks of bleeding and thromboembolic events. Several clinical practice guidelines have considered the use of antithrombotic agents pre- and post-ESD [ 1 2 3 4 5 6 ]. However, the risk of bleeding and thromboembolic events can depend on individual situations.…”

“…However, the risk of bleeding and thromboembolic events can depend on individual situations. Thus, consultation with a cardiologist or neurologist in terms of the duration of discontinuation and when to resume antithrombotic therapy may be helpful [ 2 ]. Furthermore, having a marker that could predict the bleeding risk could facilitate an individualized approach.…”

“…The risk of bleeding in the DOACs group was reported to differ according to the DOACs withdrawal time. Moreover, the withdrawal time was less than the 48 h recommended in several guidelines [ 1 2 6 8 ]. Ono et al [ 7 ] aimed to measure molecular markers predicting bleeding in patients on DXaIs.…”