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Clinical Practice Guideline for the Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal
Hyun Lim1, Eun Jeong Gong2, Byung-Hoon Min3
1Department of Gastroenterology, Hallym University Sacred Heart Hospital, Anyang, Korea.
Insights
This guideline offers the first Korean recommendations for managing patients on antithrombotic agents undergoing gastrointestinal endoscopy. It addresses clinical challenges and regional practice discrepancies for better patient care.
Area of Science:
- Gastroenterology and Hepatology
- Cardiology
- Hematology
Background:
- Increasing use of antithrombotic agents (antiplatelet agents and anticoagulants) in South Korea.
- Clinical challenge in managing patients on these agents requiring gastrointestinal endoscopy.
- Uncertainty regarding the applicability of international guidelines to the South Korean context.
Purpose of the Study:
- To establish the first Korean Clinical Practice Guideline (CPG) for managing patients on antithrombotic therapy undergoing gastrointestinal endoscopy.
- To provide evidence-based information to assist endoscopists in clinical decision-making.
- To address unmet needs and regional practice discrepancies identified in current international guidelines.
Main Methods:
- Adaptation of existing international guidelines using an evidence-based approach.
- Systematic review to retrieve four eligible guidelines.
- Evaluation of guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.
- Development of 13 statements using a grading system.
- Review by external experts.
Main Results:
- Identification of unmet needs and significant discrepancies in clinical practice across different regions.
- Establishment of 13 evidence-based statements tailored for the Korean healthcare setting.
- Development of a comprehensive guideline to support endoscopists.
Conclusions:
- The guideline provides crucial, localized recommendations for managing patients on antithrombotic agents during gastrointestinal endoscopy in Korea.
- It aims to standardize and improve the safety and efficacy of endoscopic procedures in this patient population.
- The guideline is designed to be a living document, subject to revision based on new evidence and technological advancements.
Abstract:
Antithrombotic agents, including antiplatelet agents and anticoagulants, are increasingly used in South Korea. The management of patients using antithrombotic agents and requiring gastrointestinal endoscopy is an important clinical challenge. Although clinical practice guidelines (CPGs) for the management of patients receiving antithrombotic agents and undergoing gastrointestinal endoscopy have been developed in the Unites States, Europe, and Asia Pacific region, it is uncertain whether these guidelines can be adopted in South Korea. After reviewing current CPGs, we identified unmet needs and recognized significant discrepancies in the clinical practice among regions. This is the first CPG in Korea providing information that may assist endoscopists in the management of patients on antithrombotic agents who require diagnostic or elective therapeutic endoscopy. This guideline was developed through the adaptation process as an evidence-based method, with four guidelines retrieved by systematic review. Eligible guidelines were evaluated according to the Appraisal of Guidelines for Research and Evaluation II process, and 13 statements were established using a grading system. This guideline was reviewed by external experts before an official. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.
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