title: Conflicting clinical environment about the management of antithrombotic agents during the periendoscopic period in Japan.
abstract: OBJECTIVE
  Although there are guidelines for the management of antithrombotic agents during the periendoscopic period, gaps between various guidelines create a confusing situation in daily clinical practice. The purpose of this study was to examine the current management of antithrombotic agents during the periendoscopic period in Japan.
  
  
  METHODS
  This is a prospective cohort study in 12 high-volume endoscopy centers in Japan. A total of 970 outpatients receiving antithrombotic agents underwent endoscopies (705 esophagogastroduodenoscopies and 265 colonoscopies) with or without invasive procedures. Main outcome measures are adverse events in these patients.
  
  
  RESULTS
  Need for cessation of antithrombotics before endoscopy was mostly determined by non-gastroenterologists (51%) who are unfamiliar with the Japan Gastroenterological Endoscopy Society (JGES) guideline, although cessation periods after endoscopy for most patients were determined by endoscopists (78%). Consequently, most patients underwent endoscopy without cessation (25%) or after a cessation period of 6-7 days (33%), indicating low permeation of the JGES guideline in Japan. Among 970 patients, two patients experienced major complications that may be related to thromboembolic events or gastrointestinal bleeding (95% confidence interval [CI]: 0-0.7%). One of these patients died due to sudden onset ventricular tachycardia. Invasive procedures, including 40 biopsies and two mucosal resections, were performed in 42 patients without cessation of antithrombotics, and no patients experienced major complications (95% CI: 0-8.4%).
  
  
  CONCLUSIONS
  This study revealed a conflicting clinical environment due to absence of a unified guideline in Japan. Further accumulation of data is mandatory to establish a unified guideline based upon solid evidence.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ono
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kanzaki
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Chizu
authors.initials: C
authors.lastname: Yokoi
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Masaki
authors.initials: M
authors.lastname: Sugawara
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.forename: Shoko
authors.initials: S
authors.lastname: Suzuki
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujita
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tsubata
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hirano
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Fukuzawa
authors.forename: Mikinori
authors.initials: M
authors.lastname: Kataoka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kamoshida
authors.forename: Shinji
authors.initials: S
authors.lastname: Hirai
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kondo
authors.forename: Yorimasa
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Okada
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.forename: Shoko
authors.initials: S
authors.lastname: Fujiwara
authors.forename: Shinji
authors.initials: S
authors.lastname: Morishita
authors.forename: Masao
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000009:adverse effects / Q000592:standards*; D004334:Drug Administration Schedule; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D012955:Societies, Medical / Q000592:standards; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents