Gastrointestinal Endoscopic Interventions During Antithrombotic Therapy: A Comprehensive Review of Bleeding Risk and...

Area of Science:

• Gastroenterology
• Cardiology
• Pharmacology

Background:

• Increasing use of antiplatelet and anticoagulant therapies presents challenges in periprocedural management for endoscopic procedures.
• Balancing procedural bleeding risk against thromboembolic risk is critical when managing patients on antithrombotic agents undergoing endoscopy.

Purpose of the Study:

• To review current guidelines and evidence for managing antiplatelet and anticoagulant therapy during diagnostic and therapeutic endoscopy.
• To provide guidance on continuing, interrupting, or bridging antithrombotic therapy based on procedure risk and patient factors.

Main Methods:

• Review of current society guidelines.
• Analysis of evidence from randomized trials, cohort studies, and meta-analyses.
• Evaluation of risks associated with different endoscopic procedures and antithrombotic agents.

Main Results:

• Diagnostic endoscopy with biopsy is low-risk and often requires no interruption of antithrombotics.
• High-risk therapeutic endoscopy (e.g., polypectomy, EMR, ESD) carries increased bleeding risk, especially with anticoagulants or multiple agents.
• Cold snare polypectomy shows promise as a bleeding-sparing technique for small polyps in anticoagulated patients.

Conclusions:

• Guidelines support aspirin continuation, temporary P2Y12 inhibitor interruption for high-risk procedures, brief direct oral anticoagulant interruption, and avoidance of routine heparin bridging.
• Antithrombotic management must be individualized based on procedure type, bleeding risk, and thromboembolic risk.
• Cold snare polypectomy is a recommended technique to minimize bleeding during colorectal polyp removal in patients on antithrombotic therapy.