Platelet Inhibition and Anticoagulation in Visceral Interventions

Area of Science:

• Gastroenterology and Endoscopy
• Cardiovascular Medicine
• Pharmacology

Background:

• Platelet inhibition and anticoagulation are crucial for cardiovascular health but increase gastrointestinal bleeding risk.
• Endoscopic procedures necessitate careful consideration of antithrombotic medication management.
• Harmonizing antithrombotic therapy with endoscopic interventions is a significant clinical challenge.

Purpose of the Study:

• To review current guidelines on managing antithrombotic agents during endoscopic procedures.
• To establish decision criteria for risk stratification in patients undergoing endoscopy while on antithrombotic therapy.
• To provide a framework for diagnostic and therapeutic algorithms balancing procedural and thromboembolic risks.

Main Methods:

• Systematic search of guidelines from German (DGVS), European (ESGE), and American (ASGE) gastroenterology societies.
• PubMed literature review using keywords related to hemostasis, antithrombotic drugs, platelet inhibition, anticoagulation, and endoscopy.
• Analysis of existing literature to identify decision criteria for managing antithrombotic therapy.

Main Results:

• Postponing elective endoscopy may be considered for patients on short-term antithrombotic therapy.
• Urgent endoscopy requires balancing procedural risks against the risk of thromboembolic events if medication is stopped.
• Decision criteria facilitate individual risk stratification for diagnostic and therapeutic planning.

Conclusions:

• Well-defined criteria are essential for managing endoscopic interventions when antithrombotic therapy cannot be postponed.
• Risk assessment involves evaluating both the procedural risk (low vs. high) and thromboembolic risk (low vs. high).
• An interdisciplinary approach is recommended when both procedural and thromboembolic risks are high.