Managing anticoagulation and antiplatelet medications in GI endoscopy: a survey comparing the East and the West.
BACKGROUND
Anticoagulation and antiplatelet medications may potentiate GI bleeding, and their use may lead to an increased need for a GI endoscopy. We hypothesized that there might be different practice patterns among international endoscopists.


OBJECTIVE
To explore the differences in management practices for patients who receive anticoagulation and antiplatelet medications from Eastern and Western endoscopists.


METHODS
International survey study.


METHODS
Academic medical centers and private clinics.


METHODS
Members of the American Society for Gastrointestinal Endoscopy (ASGE) in Eastern (Korea, Japan, China, India, Thailand, Singapore, Malaysia, and Philippines) and Western (United States and Canada) countries were invited to complete a Web-site-based questionnaire. In addition, the questionnaire was sent to university hospitals in South Korea and academic institutions in the United States.


METHODS
A survey was administered that contained detailed questions about the use of an endoscopy in patients on anticoagulation and antiplatelet medications.


METHODS
Different opinions and clinical practice patterns regarding the use of anticoagulation and antiplatelet medications by Eastern and Western endoscopists.


RESULTS
A total of 105 Eastern and 106 Western endoscopists completed the survey. Western endoscopists experienced more instances of procedure-related bleeding (P = .003) and thromboembolism after withdrawal of medications (P = .016). Eastern endoscopists restarted medications later (1-3 days) than Western endoscopists after a biopsy (same day) (P < .001). Eastern endoscopists withdrew aspirin for more than 7 days before a polypectomy and then restarted it 1 to 3 days after a polypectomy, whereas Western endoscopists performed a polypectomy without withdrawing aspirin (P < .001). ASGE guidelines were followed less often by Eastern than by Western endoscopists (P < .001).


CONCLUSIONS
Low response rate, heterogeneity of the sample, and recall bias.


CONCLUSIONS
The opinions and clinical practice patterns for the management of anticoagulation and antiplatelet medications differed significantly between Eastern and Western endoscopists. The lack of uniformity in practice patterns suggests that more data and better education are required in the area of GI endoscopy for patients on anticoagulation and antiplatelet medications, particularly given that individual patient characteristics may be associated with unique types of complications.
Lee
Sun-Young
SY
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Tang
Shou-jiang
SJ
Rockey
Don C
DC
Weinstein
Douglas
D
Lara
Luis
L
Sreenarasimhaiah
Jayaprakash
J
Choi
Kyoo Wan
KW
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D002170:Canada; D002983:Clinical Competence; D004724:Endoscopy / Q000592:standards* / Q000639:trends; D016099:Endoscopy, Gastrointestinal / Q000592:standards* / Q000639:trends; D005202:Asia, Eastern; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D010818:Practice Patterns, Physicians'; D011336:Probability; D011787:Quality of Health Care; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014481:United States
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors