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Antithrombotic therapy and digestive endoscopy.

Jiří Cyrany, Radovan Malý, Stanislav Rejchrt

    Vnitrni Lekarstvi
    |December 27, 2022
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    Summary
    This summary is machine-generated.

    Managing antithrombotic therapy during digestive endoscopy requires balancing bleeding risks with thromboembolic events. Guidelines help tailor treatment, ensuring patient safety and procedure efficacy.

    Keywords:
    antiplatelet therapyAntiplatelet therapyanticoagulant therapyanticoagulation therapyantithrombotic therapydigestive endoscopydirect oral anticoagulantspostprocedural bleeding

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    Area of Science:

    • Gastroenterology and Hepatology
    • Cardiology
    • Internal Medicine

    Background:

    • Antithrombotic therapy (anticoagulation and antiplatelet agents) is increasingly common.
    • Digestive endoscopy procedures are frequently indicated, necessitating careful management of patients on these therapies.
    • Interdisciplinary cooperation is crucial for safe and effective endoscopic procedures in patients on antithrombotic treatment.

    Purpose of the Study:

    • To provide an overview of antithrombotic therapy management during digestive endoscopy based on current guidelines.
    • To highlight the balance between postprocedural bleeding risk and thromboembolic risk.
    • To offer guidance on perioperative management for various antithrombotic agents.

    Main Methods:

    • Review of European, British, and North American guidelines for endoscopic procedures and perioperative care.
    • Categorization of digestive endoscopy procedures by bleeding risk.
    • Discussion of specific antithrombotic agents including aspirin, P2Y12 inhibitors, warfarin, low-molecular-weight heparin (LMWH), and direct oral anticoagulants (DOACs).

    Main Results:

    • Patients on antithrombotic therapy have an increased risk of postprocedural bleeding, which is usually manageable.
    • Thromboembolic complications can be life-threatening; postponing elective procedures may be necessary.
    • Specific recommendations exist for discontinuing and restarting various antithrombotic agents around endoscopic procedures, with bridging therapy considered for high-risk patients.

    Conclusions:

    • Individualized management of antithrombotic therapy is essential, considering both bleeding and thromboembolic risks.
    • Discontinuation of aspirin for secondary prevention is generally not recommended unless for very high-risk procedures.
    • Clear guidelines exist for managing warfarin, LMWH, and DOACs, emphasizing the importance of physician cooperation and patient information.