Management of Patients on Antithrombotic Agents Undergoing Endoscopy

Joon Sung Kim; Byung-Wook Kim

doi:10.4166/kjg.2018.71.5.282

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Kim and Kim: Management of Patients on Antithrombotic Agents Undergoing Endoscopy

Brief Summary of Practice Guideline

Korean J Gastroenterol 2018;71(5):282-285.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.5.282

Management of Patients on Antithrombotic Agents Undergoing Endoscopy

Joon Sung Kim, Byung-Wook Kim

Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

Correspondence to: Byung-Wook Kim, Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Korea. Tel: +82-32-280-5051, Fax: +82-32-280-5082, E-mail: gastro@catholic.ac.kr

Received 18 April 2018 Revised 11 May 2018 Accepted 11 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Antithrombotic agents are used increasingly in Asia. The management of patients on antithrombotics undergoing elective or emergency endoscopy has become an increasing clinical challenge for gastroenterologists. Current practice guidelines have been developed by societies from western countries. On the other hand, these guidelines cannot meet the specific needs of the Asian Pacific region, raising the need for separate guidelines in Asia. This review compares the recommendations of previous guidelines with the most recently published Asian guidelines regarding the management of patients on antithrombotic agents undergoing elective and emergency endoscopy.

Keywords: Antithrombotic agents, Endoscopy, Guideline

References

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Table 1.

Management of Antithrombotics in Patients with Non-variceal Upper GI Bleeding^2,3,5

	APAGE-APSDE	ASGE	ESGE
DAPT	Continue aspirin withhold other antiplatelet up to 5 days after hemostasis	Consult cardiologist	Continue aspirin consult cardiologist for resumption of other antiplatelet
Warfarin	Resume by day 3 if hemostasis is achieved	Not mentioned	Resume between 7 and 15 days after bleeding event
	Consider heparin bridge therapy in high thrombotic risk patients
DOACs	Resume by day 3 if hemostasis is achieved	Not mentioned	Not mentioned
	Heparin bridge therapy is not required

APAGE, Asian Pacific Association of Gastroenterology; APSDE, Asian Pacific Society for Digestive Endoscopy; ASGE, American Society of Gastrointestinal Endoscopy; ESGE, European Society of Gastrointestinal Endoscopy; DAPT, dual antiplatelet therapy; DOACs, direct oral anticoagulants.

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