title: Clinical management of esophagogastroduodenoscopy by clinicians under the former guidelines of the Japan Gastroenterological Endoscopy Society for patients taking anticoagulant and antiplatelet medications.
abstract: BACKGROUND
  The 2005 Japan Gastroenterological Endoscopy Society (JGES) guidelines for the management of antithrombotic drugs focused on the increasing risks of bleeding, even from biopsy during scheduled esophagogastroduodenoscopy (EGD). The new 2012 guidelines emphasized the prevention of thromboembolic complications. To compare with the new guidelines, we investigated the clinical management of EGD by clinicians under the former JGES guidelines for patients taking antithrombotic agents.
  
  
  METHODS
  Medical records of 4574 patients (mean age 63.4 years, range 3-96 years, male/female ratio 2805/1769) who underwent scheduled EGD from April 2011 to March 2012 were reviewed retrospectively. The prescribed agents, pre-existing comorbidities, drug cessation before EGD, bleeding, and thromboembolic complications were investigated.
  
  
  RESULTS
  Five hundred forty-six patients (12.0 %) were taking antithrombotic drugs (aspirin, 313; warfarin, 134; cilostazol, 57; clopidogrel, 59; ethylicosapentate, 40; prostaglandin preparations, 41; ticlopidine, 29; icosapentate, 24; dipyridamole, 4); 116 and 29 patients, respectively, were managed with a combination of 2 or 3 agents. Among 490 patients whose medical records were precisely documented, 40.6 % underwent EGD without cessation. Bleeding and thromboembolic complications were not observed. The most common pre-existing comorbidity was ischemic heart disease (27.9 %), followed by carotid or intracranial large artery atherosclerosis (20.5 %), cerebral infarction or transient ischemic attack (20.3 %), and atrial fibrillation (15.9 %). Patients with pre-existing comorbidity requiring anticoagulants frequently underwent EGD without cessation.
  
  
  CONCLUSIONS
  We revealed the low impact of the 2005 JGES guidelines on the management of antithrombotic drugs. Our physicians have reasonably decided to continue antithrombotic drugs before EGD according to the risk of thromboembolism.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Iwatsuka
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.forename: Chika
authors.initials: C
authors.lastname: Kusano
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Fukuzawa
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawai
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016145:Endoscopy, Digestive System / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017408:Guidelines as Topic; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors