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[Antithrombotic therapy and digestive endoscopy: a difficult management.]

Vincenzo De Francesco1, Raffaele Manta2, Angelo Zullo3

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Summary

Managing patients on antithrombotic therapy before gastrointestinal endoscopy requires balancing bleeding risks. This review provides guidance on antithrombotic drug management for endoscopic procedures, including newer anticoagulants.

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Area of Science:

  • Gastroenterology and Internal Medicine
  • Cardiology

Background:

  • Antithrombotic therapies are crucial for preventing thromboembolic events in high-risk patients.
  • Gastrointestinal endoscopic procedures are increasingly common for diagnosis and treatment.
  • Concurrent use of antithrombotics and endoscopy necessitates careful risk management.

Purpose of the Study:

  • To review international guidelines for managing patients on antithrombotic therapy undergoing gastrointestinal endoscopy.
  • To provide practical tools for physicians, especially general practitioners, managing these patients.
  • To address the distinct management of direct-acting anticoagulants compared to traditional ones.

Main Methods:

  • Review of current international guidelines and recommendations.
  • Analysis of pharmacological management strategies for antithrombotic drugs.
  • Development of schematic tools for clinical decision-making.

Main Results:

  • Antithrombotic therapy management for endoscopy involves balancing procedural bleeding risk against thromboembolic event risk.
  • Direct-acting anticoagulants require specific management protocols distinct from vitamin K antagonists.
  • General practitioners play a key role in managing patients undergoing 'open access' endoscopic procedures.

Conclusions:

  • Optimal management of antithrombotic therapy before gastrointestinal endoscopy is essential to minimize patient risk.
  • Adherence to updated guidelines and understanding of different anticoagulant classes are critical.
  • Physicians need practical tools to guide safe and effective patient care.