Management of anticoagulation before and after gastrointestinal endoscopy.
The management of anticoagulants and antiplatelet agents in patients undergoing gastrointestinal endoscopic procedures is a common clinical problem. Although guidelines have been published, they are supported by little prospective or randomized trial data, but are primarily based on observational studies, expert opinion, and best clinical practices. As a general principle, the risks of thromboembolism need to be balanced against the risks of bleeding during the endoscopic procedure. By understanding these risks, management plans for individual cases may be made. This article reviews the current data and guidelines on the management of anticoagulants, antiplatelet agents, use of reversal agents, and the role and risks of concomitant proton pump inhibitors.
Kwok
Avelyn
A
Department of Gastroenterology, Concord Hospital, University of Sydney, Sydney, Australia.
Faigel
Douglas O
DO
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D010347:Patient Care Planning; D010949:Plasma; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D011516:Prothrombin / Q000008:administration & dosage; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D014812:Vitamin K / Q000008:administration & dosage
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D014812:Vitamin K; D011516:Prothrombin