title: Antiplatelet and anticoagulant drugs management before gastrointestinal endoscopy: do clinicians adhere to current guidelines?
abstract: BACKGROUND
  Managing antiplatelet and anticoagulant drugs before endoscopy may be challenging.
  
  
  OBJECTIVE
  To assess whether the pre-endoscopic management of antiplatelet/anticoagulant drugs is adherent to current guidelines and the influence of patients' characteristics, referring physician's specialty, type of endoscopic procedure and therapeutic regimen on adherence.
  
  
  METHODS
  Two hundred and twenty patients taking aspirin, thienopyridines or warfarin and scheduled for upper endoscopy (± biopsies), variceal band ligation, colonoscopy (± biopsies or polypectomy), were prospectively analyzed.
  
  
  RESULTS
  In 109 patients (49.5%) the management of antiplatelet/anticoagulant drugs was thoroughly compliant with guidelines. Neither demographic characteristics, nor in/outpatient status, nor type of endoscopic procedure, nor physician's specialty influenced the adherence but the therapeutic regimen had a significant impact (p < 0.0001) as compliance was less likely in patients on warfarin. Unwarranted drugs withholding was more frequent before colonoscopy than upper endoscopy (p = 0.0001). Warfarin was stopped longer than recommended more frequently than aspirin (p = 0.009). The International Normalized Ratio was properly checked before endoscopy in 47.7% of patients. Among the 55 patients who withheld warfarin, the decision about bridging to low molecular weight heparin was appropriate in 21 (38.2%).
  
  
  CONCLUSIONS
  Compliance with guidelines is low especially in the management of warfarin, both among gastroenterologists and other physicians.
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bruno
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marengo
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Elia
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Caronna
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Wilma
authors.initials: W
authors.lastname: Debernardi-Venon
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Selene Francesca
authors.initials: SF
authors.lastname: Manfrè
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Musso
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Puglisi
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Sguazzini
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Città della Salute e della Scienza di Torino, San Giovanni Battista Hospital, University of Turin, Italy. Electronic address: eusdeang@hotmail.com.
authors.forename: Claudio
authors.initials: C
authors.lastname: De Angelis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D001706:Biopsy; D015331:Cohort Studies; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy / Q000379:methods / Q000592:standards; D016145:Endoscopy, Digestive System / Q000379:methods / Q000592:standards; D016099:Endoscopy, Gastrointestinal / Q000379:methods* / Q000592:standards; D004932:Esophageal and Gastric Varices / Q000601:surgery; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D058924:Thienopyridines / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D058924:Thienopyridines; D014859:Warfarin; D001241:Aspirin
keywords: Antithrombotic drugs; Compliance; Digestive endoscopy; Guidelines