Multi‐center survey regarding the management of anticoagulation and antiplatelet therapy for endoscopic procedures in Japan

Abstract

There is still a wide variation and confusion among endoscopists after establishment of our national guideline. A robust national guideline with clearer description based on the scientific evidence is needed.

Can Endoscopists Become More Aggressive or Have More Options for Patients with Antithrombotic Agents?

“…Furthermore, the survey also revealed, interestingly, that personal experience seemed to be a more powerful driver of practice than the published guidelines, even among Western endoscopists. Our multicenter questionnaire in Japan also revealed the low permeation of the Japanese guideline [7], which might be caused by the fact that major parts of these guidelines were established by experts' opinions or limited studies with low evidence level.…”

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

“…We do not have any original written criteria concerning the management of antithrombotic drugs and pre-existing comorbidities. Therefore, the cessation had been principally determined by the doctors who order EGD or who prescribe antithrombotic drugs as in many institutions in Japan [9]. However, they are not necessarily the performers of EGD.…”

“…There is no solid evidence, however, to support higher bleeding risk in Asians; several studies reported that no complications related to bleeding were observed in Japanese patients who underwent endoscopic biopsy without cessation of antithrombotic drugs [9,[17][18][19].…”

“…Discontinuation of these agents during the periendoscopic period can induce thromboembolic complications. When these occur, the mortality rate from embolism is higher than that from bleeding [9]. Therefore, the dilemma between the risks of thromboembolic events and gastrointestinal bleeding, and the difficulty in estimating thromboembolic risk for each patient's comorbidity, have been major concerns for endoscopists.…”

Reply: A guideline to fill the gap between endoscopists and physicians who prescribe anticoagulant and/or antiplatelet agents

“…Additionally, the skill level of the endoscopist might affect the bleeding rate, as mentioned in the letter. However, thromboembolic complications sometimes have lethal outcomes, including acute coronary syndrome or cerebral infarction [2,3]. Endoscopists should not put patients at unnecessary thromboembolic risk because of poor training and skills.…”