Novel Oral Anticoagulants in the Peri-Endoscopic Period
Michael Genualdi1, Edward Lebovics, And William H Frishman
1From the *Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; †Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY; and ‡Department of Medicine, Division of Gastroenterology and Hepato-Biliary Diseases, New York Medical College/Westchester Medical Center, Valhalla, NY.
Abstract:
Millions of patients in the United States are currently prescribed some form of anticoagulation therapy. Recently, novel oral anticoagulants (NOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, have begun to replace warfarin as the drugs of choice for anticoagulation. As the use of these medications becomes more widespread, it is increasingly important for gastroenterologists to understand the risks associated with performing endoscopic procedures on patients who are taking NOACs. In this review, we provide an overview of the NOACs and current guidelines from international societies regarding the management of patients scheduled to undergo endoscopic procedures who are prescribed these medications. Finally, we offer a perspective on future studies required to adequately investigate and characterize the effects that these drugs have on a patient's risk for bleeding in the peri- and/or postprocedural timeframes.
Insights
Novel oral anticoagulants (NOACs) are replacing warfarin for anticoagulation. This review covers NOACs, guidelines for endoscopic procedures, and future research on bleeding risks.
Area of Science:
- Gastroenterology
- Pharmacology
- Cardiology
Background:
- Anticoagulation therapy is common in the US.
- Novel oral anticoagulants (NOACs) are increasingly used, replacing warfarin.
- Gastroenterologists need to understand NOACs for endoscopic procedures.
Purpose of the Study:
- To review NOACs and current guidelines for managing patients undergoing endoscopy.
- To highlight the importance of understanding NOACs' peri- and postprocedural bleeding risks.
Main Methods:
- Literature review of NOACs.
- Analysis of international society guidelines.
- Discussion of peri- and postprocedural bleeding risks.
Main Results:
- NOACs include direct thrombin inhibitors and direct factor Xa inhibitors.
- Guidelines exist for managing patients on anticoagulation during endoscopy.
- Further research is needed on NOACs' specific bleeding risks.
Conclusions:
- Understanding NOACs is crucial for gastroenterologists performing procedures.
- Current guidelines provide a framework for managing patients on NOACs.
- Future studies should focus on peri- and postprocedural bleeding risks associated with NOACs.
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