title: Prevention of gastrointestinal events in patients on antithrombotic therapy in the peri-endoscopy period: review of new evidence and recommendations from recent guidelines.
abstract: Management of patients on antithrombotic therapy undergoing endoscopic procedures can be challenging. Although guidelines from major gastrointestinal endoscopy societies provide useful recommendations in this regard, data are limited concerning the bleeding risk of new complex endoscopic procedures and the management of novel anticoagulants in patients needing invasive procedures. The approach to the management of antithrombotic therapy often needs to be formulated on an individual basis, especially in patients with high thrombotic risk undergoing a high-risk endoscopic procedure. In addition to the procedure-related bleeding risk, endoscopists also need to consider the urgency of the endoscopic procedure, the thromboembolic risk of the patient if antithrombotic therapy is temporarily withheld, and the timing of discontinuation/resumption of antithrombotic therapy in the decision-making process. Diagnostic endoscopic procedures with or without biopsy can often be done without interruption of antithrombotic therapy. If possible, elective procedures with high bleeding risk should be delayed in patients on antithrombotic therapy for conditions with high thrombotic risk. If high-risk procedures cannot be delayed in these patients, thienopyridines, traditional and novel anticoagulants are usually withheld, whereas aspirin withdrawal is decided on a case by case basis. In patients with high thrombotic risk, communication with the prescribing clinician before proceeding to procedures with high bleeding risk is particularly important in optimizing the peri-procedural management plan of antithrombotic therapy.
authors.affiliation: Institute of Digestive Disease, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
authors.forename: Raymond S Y
authors.initials: RS
authors.lastname: Tang
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
authors.forename: Francis K L
authors.initials: FK
authors.lastname: Chan
mesh_terms: D016099:Endoscopy, Gastrointestinal; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D017410:Practice Guidelines as Topic; D013927:Thrombosis / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents
keywords: anticoagulant; antiplatelet; bleeding risk; endoscopy; thromboembolic risk