title: New anticoagulant and antiplatelet agents: a primer for the gastroenterologist.
abstract: A large number of patients worldwide receive anticoagulant and antiplatelet agents, collectively known as antithrombotic agents. Several new anticoagulants and antiplatelet agents recently were approved for use. Gastroenterologists may be unfamiliar with the mechanism of action, indications for use, and pharmacokinetics of these newer drugs. In patients undergoing elective and urgent endoscopic procedures, clinicians must be familiar with these medications to optimize outcomes. When the decision is made to continue the newer antithrombotic agents for elective procedures, the clinician must understand the risk that these agents may impart on procedural-induced bleeding. Finally, it is important to understand how to manage these agents in the presence of acute gastrointestinal bleeding. In this article the use of newer antithrombotic agents is reviewed.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: baron.todd@mayo.edu.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: Division of Cardiovascular Diseases, Division of Hematology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert D
authors.initials: RD
authors.lastname: McBane
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001562:Benzimidazoles / Q000008:administration & dosage; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D000077144:Clopidogrel; D000069604:Dabigatran; D004347:Drug Interactions; D000077425:Fondaparinux; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D011134:Polysaccharides / Q000008:administration & dosage; D000068799:Prasugrel Hydrochloride; D054328:Proton Pump Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D058921:Purinergic P2Y Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D013876:Thiophenes / Q000494:pharmacology / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D015091:beta-Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D001779:Blood Coagulation Factors; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D011134:Polysaccharides; D054328:Proton Pump Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D015091:beta-Alanine; C025667:prothrombin complex concentrates; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000069604:Dabigatran; D000077425:Fondaparinux; D013988:Ticlopidine
keywords: AF; Anticoagulants/Administration and Dosage; Atrial Fibrillation; CrCl; DTI; DVT; DXI; Drug Administration Schedule; Drug Monitoring; ERCP; Endoscopy; FDA; FEIBA; FVII; Factor VII; Factor VIII inhibitor bypass activity; Food and Drug Administration; GI; Gastrointestinal; MI; PCC; PCI; PE; PT; TT; Thrombosis/Drug Therapy; aPTT; activated partial thromboplastin time; atrial fibrillation; creatinine clearance; deep venous thrombosis; direct factor X inhibitor; direct thrombin inhibitor; endoscopic retrograde cholangiopancreatography; gastrointestinal; myocardial infarction; percutaneous coronary intervention; prothrombin complex concentrate; prothrombin time; pulmonary embolism; rFVIIa; recombinant FVIIa; thrombin time