Management of antithrombotic agents for endoscopic procedures

Anderson, Michelle A.; Ben–Menachem, Tamir; Gan, S. Ian; Appalaneni, Vasundhara; Banerjee, Subhas; Cash, Brooks D.; Fisher, Laurel; Harrison, M. Edwyn; Fanelli, Robert D.; Fukami, Norio; Ikenberry, Steven O.; Jain, Rajeev; Khan, Khalid; Krinsky, Mary Lee; Lichtenstein, David R.; Maple, John T.; Shen, Bo; Strohmeyer, Laura; Baron, Todd H.; Dominitz, Jason A.

doi:10.1016/j.gie.2009.09.040

Cited by 479 publications

(313 citation statements)

References 79 publications

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“…Another possible reason for the low permeation of the 2005 JGES guidelines might be the publishing of the 2009 ASGE guidelines [16], but there were no similar clinical studies concerning the management of antithrombotic agents for EGD before the 2009 ASGE guidelines were published that can be compared with our study. Only 1 study about the management of antithrombotic agents for endoscopy before the 2009 ASGE guidelines were published was reported by Ono et al [17], but the participating patients included not only patients who underwent scheduled EGD, but also patients who underwent colonoscopy, EUS, and invasive procedures (EMR, ESD).…”

Section: Discussionmentioning

confidence: 78%

“…The feature of these guidelines is that the risk of procedure-related bleeding is more heavily weighted than the risk of a thromboembolism caused by ceasing these medications, based on the solitary study [11]. In these guidelines, cessation is recommended even for scheduled esophagogastroduodenoscopy (EGD) including biopsy, although cessation is not indicated as necessary in most western guidelines [12][13][14][15][16]. This difference was based on racial differences in bleeding risk between Asians and Caucasians as mentioned in the 2005 JGES guidelines [10].…”

Section: Introductionmentioning

confidence: 99%

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Clinical management of esophagogastroduodenoscopy by clinicians under the former guidelines of the Japan Gastroenterological Endoscopy Society for patients taking anticoagulant and antiplatelet medications

et al. 2014

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Background The 2005 Japan Gastroenterological Endoscopy Society (JGES) guidelines for the management of antithrombotic drugs focused on the increasing risks of bleeding, even from biopsy during scheduled esophagogastroduodenoscopy (EGD). The new 2012 guidelines emphasized the prevention of thromboembolic complications. To compare with the new guidelines, we investigated the clinical management of EGD by clinicians under the former JGES guidelines for patients taking antithrombotic agents. Methods Medical records of 4574 patients (mean age 63.4 years, range 3-96 years, male/female ratio 2805/1769) who underwent scheduled EGD from April 2011 to March 2012 were reviewed retrospectively. The prescribed agents, pre-existing comorbidities, drug cessation before EGD, bleeding, and thromboembolic complications were investigated. Results Five hundred forty-six patients (12.0 %) were taking antithrombotic drugs (aspirin, 313; warfarin, 134; cilostazol, 57; clopidogrel, 59; ethylicosapentate, 40; prostaglandin preparations, 41; ticlopidine, 29; icosapentate, 24; dipyridamole, 4); 116 and 29 patients, respectively, were managed with a combination of 2 or 3 agents. Among 490 patients whose medical records were precisely documented, 40.6 % underwent EGD without cessation.Bleeding and thromboembolic complications were not observed. The most common pre-existing comorbidity was ischemic heart disease (27.9 %), followed by carotid or intracranial large artery atherosclerosis (20.5 %), cerebral infarction or transient ischemic attack (20.3 %), and atrial fibrillation (15.9 %). Patients with pre-existing comorbidity requiring anticoagulants frequently underwent EGD without cessation. Conclusion We revealed the low impact of the 2005 JGES guidelines on the management of antithrombotic drugs. Our physicians have reasonably decided to continue antithrombotic drugs before EGD according to the risk of thromboembolism.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Clinical management of esophagogastroduodenoscopy by clinicians under the former guidelines of the Japan Gastroenterological Endoscopy Society for patients taking anticoagulant and antiplatelet medications

et al. 2014

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“…Thus, the American Society for Gastrointestinal Endoscopy (ASGE) recommends continuing aspirin and NSAIDs if one of them is used alone and if its use is necessary [24][25][26][27]. However, there is some evidence that combination of aspirin with one or more NSAIDs may increase the risk of bleeding after polypectomy; therefore discontinuation of NSIADs 2-3 days before polypectomy is recommended in patients receiving aspirin [24][25][26][27]. Also, use of clopidogrel alone does not increase risk of postpolypectomy bleeding; however, concomitant use of aspirin or any other NSAIDs increases the risk of bleeding [3,24,25,28].…”

Section: Bleedingmentioning

confidence: 99%

“…Pre-procedure warfarin use increases risk of bleeding after colonoscopy, thus discontinuation of warfarin is recommended 3-5 days before colonoscopy, however bridging with hepa-rin or its equivalents is important in high risk patients for thrombosis such as a mechanical cardiac valve [3,14,24,25,29].…”

Section: Bleedingmentioning

confidence: 99%

Complications of Colonoscopy

Waye

Aisenberg

Rubin

2013

Practical Colonoscopy

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“…A pesar de la importancia de este tema, no se han realizado estudios prospectivos o controlados que permitan formular protocolos para la realización de las diversas técnicas endoscópicas diagnósticas o terapéuticas en pacientes con terapia antiembólica, pero sí existen muchas guías de manejo formuladas por las más importantes sociedades científicas que orientan en la atención de este tipo de pacientes (4,5).…”

Section: Introductionunclassified

Procedimientos endoscópicos y terapias antitrombóticas, una visión actual

Ortíz

Segura²,

Acuña³

et al. 2017

Rev. Colomb. Gastroenterol.

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En los últimos años se ha generado un avance importante en el tratamiento de las patologías procoagulantes con antiguos y nuevos medicamentos y se ha logrado un importante avance en los métodos diagnósticos y terapéuticos en la endoscopia digestiva. Por otra parte, la expectativa de vida de la población mundial se ha incrementado de forma considerable, por lo que más frecuentemente el gastroenterólogo debe realizar procedimientos endoscópicos, en pacientes de mayor edad, quienes presentan comorbilidades por las que reciben terapias antitrombóticas, especialmente por patologías cardiovasculares.En la literatura aparecen muchas guías de manejo avaladas por importantes asociaciones, en las que se orienta en la realización de procedimientos endoscópicos en los pacientes sometidos a terapias antitrombóticas, procedimientos que representan un determinado riesgo de sangrado, o trombosis en caso de la suspensión de los medicamentos, pero no se han realizado estudios prospectivos o controlados que permitan formular protocolos para las diversas técnicas endoscópicas diagnósticas o terapéuticas en estos pacientes. El gastroenterólogo debe realizar un balance entre el riesgo hemorrágico y el riesgo embólico para determinar cuál es el momento más indicado para realizar un procedimiento endoscópico en estos pacientes, por lo tanto, es de gran importancia que tenga conocimiento de este tema.Presentamos una revisión actualizada de la literatura y las más recientes recomendaciones de la sociedad europea de gastroenterología.

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Management of antithrombotic agents for endoscopic procedures

Cited by 479 publications

References 79 publications

Clinical management of esophagogastroduodenoscopy by clinicians under the former guidelines of the Japan Gastroenterological Endoscopy Society for patients taking anticoagulant and antiplatelet medications

Clinical management of esophagogastroduodenoscopy by clinicians under the former guidelines of the Japan Gastroenterological Endoscopy Society for patients taking anticoagulant and antiplatelet medications

Complications of Colonoscopy

Procedimientos endoscópicos y terapias antitrombóticas, una visión actual

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