title: Endoscopy in the patient on antithrombotic therapy.
abstract: OBJECTIVE
  The management of antithrombotics during the periendoscopic period is a common clinical problem. This review focuses on recent literature addressing this issue, primarily on articles published from 2009 to 2012.
  
  
  RESULTS
  A large proportion of the studies retrieved focused on the effect of antithrombotics on bleeding risk following diagnostic endoscopy, polypectomy, endoscopic mucosal resection, and submucosal dissection, whereas studies involving other endoscopic procedures were scarce. Recent American and European guidelines direct the management of antithrombotic therapy in patients undergoing endoscopy according to the procedure's risk of bleeding and the patient's thromboembolic risk. The difficulty in determining a priori the need for endotherapy and hence appropriate classification of risk of bleeding prior to the procedure is a potential limitation of such classification. Moreover, most studies have primarily addressed the risk of immediate or early bleeding by proposing interruption of antithrombotic therapy prior to endotherapy, and few have focused on the risk of delayed bleeding and the optimal time for resumption of these agents following high-risk procedures.
  
  
  CONCLUSIONS
  Management of patients on antithrombotics remains complex, especially in high-risk settings. Existing guidelines are valuable but should not be a substitute for a careful personalized risk assessment strategy involving patient and physician.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hussein
authors.initials: H
authors.lastname: Abu Daya
authors.forename: Lara
authors.initials: L
authors.lastname: Younan
authors.forename: Ala I
authors.initials: AI
authors.lastname: Sharara
mesh_terms: D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy / Q000009:adverse effects; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005753:Gastric Mucosa / Q000601:surgery; D005774:Gastrostomy / Q000009:adverse effects; D017408:Guidelines as Topic; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D018570:Risk Assessment; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents