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Differences in Managing Anticoagulants and Antiplatelets for Gastrointestinal Endoscopy between East and West
1Department of Internal Medicine, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, South Korea.
Insights
Managing anticoagulation and antiplatelet medications for gastrointestinal endoscopy requires different approaches for Eastern and Western patients. This is due to variations in drug metabolism, bleeding risk, and embolism types.
Area of Science:
- Gastroenterology
- Pharmacology
- Cardiology
Background:
- Managing anticoagulation and antiplatelet medications during gastrointestinal (GI) endoscopic procedures presents a critical balance between bleeding and thromboembolic risks.
- Current Western guidelines for managing these medications in GI endoscopy may not be universally applicable, potentially leading to adverse events in Eastern populations.
Approach:
- This analysis considers differences in drug metabolism, hemorrhage risk, and thromboembolic patterns between Eastern and Western patients undergoing GI endoscopy.
- Investigates the predisposition of Asian populations to cerebrovascular events versus Western populations' tendency towards cardiovascular events during drug cessation.
Key Points:
- Eastern patients exhibit greater body weight-normalized plasma unbound clearance of drugs, impacting medication management.
- Adherence to Western guidelines by Eastern endoscopists may contribute to higher rates of massive bleeding.
- Distinct management strategies are necessary, accounting for ethnic variations in drug metabolism and embolism risks.
Conclusions:
- A one-size-fits-all approach to managing anticoagulation and antiplatelet therapy in GI endoscopy is inadequate.
- Tailored management protocols are essential for GI endoscopy patients on these medications, considering East-West differences in metabolism, bleeding, and thromboembolism.
Abstract:
Decreasing the bleeding risk associated with gastrointestinal (GI) endoscopic procedures and minimizing the thromboembolic risk of withdrawing medications are very important for the patients taking anticoagulants and antiplatelets. Western guidelines on managing anticoagulation and antiplatelet medications in GI endoscopy suggest a polypectomy with aspirin medication or a biopsy with warfarin medication. However, Eastern endoscopists' adherence to Western guidelines may be responsible for Easteners experiencing massive bleedings. During the cessation of drugs, it should be emphasized that Asians may be predisposed to different forms of embolism more likely to be of the cerebrovascular system, whereas Westerners more likely to be of the cardiovascular variety. To better understand the differences between the East and West, differences in drug metabolism should be considered that results in greater body weight-normalized plasma unbound clearance of drug in Easterners. Taken as a whole, different managements are required for GI endoscopy in patients on anticoagulation and/or antiplatelet medications based on differences in metabolism of drugs, risk of hemorrhage, and forms of thromboembolism.
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