Management of antiplatelet and anticoagulant therapy for endoscopic procedures: Introduction to novel oral anticoagulants

Abstract

The development of novel antithrombotic therapy in the past few years and its prescription in patients with cardiovascular and circulatory disease has widened the spectrum of drugs that need to be considered when performing an endoscopic procedure. The balance between the thrombotic risk patients carry due to their medical history and the bleeding risk involved in endoscopic procedures should be thoroughly analyzed by Gastroenterologists. New oral anticoagulants (NOACs) impose an additional task. These agents, that specifically target factor IIa or Xa, do not dispose of an anticoagulation monitoring method nor have an antidote to revert their effect, just as with antiplatelet agents. Understanding the fundamental aspects of these drugs provides the necessary knowledge to determine the ideal period the antithrombotic therapy should be interrupted in order to perform the endoscopic procedure, offering maximum safety for patients and optimal results.

Manajemen Terapi Antitrombotik pada Prosedur Endoskopi

“…Beberapa hal penting yang perlu diperhatikan tentang manajemen periondoskopik pada kelompok pasien yang menggunakan antitrombotik, yaitu: 1) risiko perdarahan akibat tindakan dan pengaruh antitrombotik; 2) risiko kejadian tromboemboli terkait dengan penghentian sementara obat antitrombotik periprosedural; dan 3) urgensi dari tindakan yang dilakukan. 2,8…”

“…Pada pasien dengan risiko perdarahan tinggi yang telah berhasil dilakukan prosedur endoskopi, disarankan untuk menggunakan UFH karena memiliki waktu paruh yang singkat. 2,8 Pada pasien yang mendapatkan antiplatelet dan mengalami perdarahan saluran cerna akut yang mengancam jiwa, penghentian pemberian terapi dapat dipertimbangkan. Dianjurkan untuk berkonsultasi dengan spesialis yang bersangkutan perihal penghentian antiplatelet terkait dengan beberapa kondisi, antara lain pasien dengan pemasangan stent DES <1 tahun, pasien dengan pemasangan BMR <1 tahun, atau pasien dengan riwayat ACS 90 hari sebelumnya.…”

Endoscopic resection of colorectal polyps in patients on antiplatelet therapy: an evidence-based guidance for clinicians

“…Two recent reviews have covered this topic (17,18), therefore we will only mention this briefly, commenting only on commercially available oral drugs. Platelets circulate in an inactive state, but they activate rapidly following interaction with the exposed subendothelial tissue.…”