Gut-2016-Veitch-374-89.pdf (734.85 kB)
Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines
journal contribution
posted on 2016-06-08, 10:24 authored by Andrew M. Veitch, Geoffroy Vanbiervliet, Anthony H. Gershlick, Christian Boustiere, Trevor P. Baglin, Lesley-Ann Smith, Franco Radaelli, Evelyn Knight, Ian M. Gralnek, Cesare Hassan, Jean-Marc DumonceauThe risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage vs. thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor): For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation);For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation).For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation). Warfarin: The advice for warfarin is fundamentally unchanged from BSG 2008 guidance. Direct Oral Anticoagulants (DOAC): For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation). For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥ 48 hours before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (or estimated glomerular filtration rate, eGFR) of 30 - 50 mL/min we recommend that the last dose of DOAC be taken 72 hours before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation).
History
Citation
Endoscopy, 2016, 48 (4), pp. 385-402Author affiliation
/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Cardiovascular SciencesVersion
- VoR (Version of Record)
Published in
EndoscopyPublisher
Thieme Publishing for European Society of Gastronintestinal Endoscopy (E.S.G.E.)eissn
1438-8812Acceptance date
2016-01-04Copyright date
2016Available date
2016-06-08Publisher DOI
Publisher version
https://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-102652Language
enAdministrator link
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