title: Managing anticoagulation and antiplatelet medications in GI endoscopy: a survey comparing the East and the West.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Lee
authors.forename: Shou-jiang
authors.initials: SJ
authors.lastname: Tang
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
authors.forename: Douglas
authors.initials: D
authors.lastname: Weinstein
authors.forename: Luis
authors.initials: L
authors.lastname: Lara
authors.forename: Jayaprakash
authors.initials: J
authors.lastname: Sreenarasimhaiah
authors.forename: Kyoo Wan
authors.initials: KW
authors.lastname: Choi
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors