Antiplatelet and anticoagulant drugs management before gastrointestinal endoscopy: Do clinicians adhere to current guidelines?

Bruno, Mauro; Marengo, Arianna; Elia, Chiara; Caronna, S.; Debernardi-Venon, W.; Manfrè, Selene Francesca; Musso, Alessandro; Puglisi, Fabrizio; Sguazzini, C; Rizzetto, M.; Angelis, Claudio De

doi:10.1016/j.dld.2014.10.017

Cited by 11 publications

(6 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…34 This contributes to explain the lack of uniformity in the management of anticoagulation in the periendoscopic period worldwide. 8,20,35,36 In our study, 12 patients only were under warfarin before EVL. In these patients, initial imbrication was strictly applied according to guidelines, including administration of vitamin K, 27 but anticoagulant dose of LMWH were maintained thereafter until eradication was achieved (as in patients already on LMWH before EVL).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, timing of warfarin withdrawal and imbrication with LMWH has been extrapolated from studies on patients undergoing colonic endoscopic polypectomy . This contributes to explain the lack of uniformity in the management of anticoagulation in the peri‐endoscopic period worldwide . In our study, 12 patients only were under warfarin before EVL.…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that anticoagulants do not increase the risk of death associated with acute upper‐gastrointestinal bleeding in patients with cirrhosis . However, management of anticoagulation therapy in patients scheduled to endoscopic variceal ligation (EVL) for primary or secondary prophylaxis of variceal bleeding is still a matter of debate owing to the lack of dedicated studies . Anticoagulants are frequently stopped or the endoscopic procedure is delayed/contraindicated fearing causal haemorrhagic complications.…”

Section: Introductionmentioning

confidence: 99%

“…7 However, management of anticoagulation therapy in patients scheduled to endoscopic variceal ligation (EVL) for primary or secondary prophylaxis of variceal bleeding is still a matter of debate owing to the lack of dedicated studies. 4,5,[8][9][10] Anticoagulants are frequently stopped or the endoscopic procedure is delayed/contraindicated fearing causal haemorrhagic complications. Major concern is that anticoagulants may worsen bleeding from post-banding ulcers, 11,12 which, with a risk ranging from 0.5% to 3% in primary prophylaxis, 13 frequently occurs within 2 weeks from the procedure.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Low molecular weight heparin does not increase bleeding and mortality post‐endoscopic variceal band ligation in cirrhotic patients

Bianchini

Cavani

Bonaccorso

et al. 2018

Liver International

View full text Add to dashboard Cite

Five hundred fifty-three EVLs were performed in 265 patients (in 215 as a primary prophylaxis): 169 EVLs in 80 on-LMWH and 384 in 185 no-LMWH (4.9 ± 1.1 vs 4.8 ± 1.0 bands/session, respectively; P = .796). Six patients bled (2.2%) without between-groups difference (3.8% on-LMWH vs 1.6% no-LMWH, Log-rank P = .291). Large varices with red marks (100% vs 51.4%, P = .032), number of bands (5.6 ± 0.5 vs 4.6 ± 1.2, P = .004), underlying portal vein thrombosis (66.7% vs 23.6%, P = .033), and creatinine (2.2 ± 2.7 vs 1.0 ± 0.8 mg/dL, P = .001) at index EVL were significantly different between bleeders and non-bleeders. Six patients died within 4-week from index EVL, without between-groups difference (2.5% on-LMWH vs 2.2% no-LMWH, Log-rank P = .863). LMWH does not increase the risk of post-procedural bleeding and does not affect survival of cirrhotic patients undergoing prophylactic EVL.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Low molecular weight heparin does not increase bleeding and mortality post‐endoscopic variceal band ligation in cirrhotic patients

Bianchini

Cavani

Bonaccorso

et al. 2018

Liver International

View full text Add to dashboard Cite

show abstract

“…This is likely not unique to our area, however, as a review of preparation instructions from 317 endoscopy units found that only 43.5 % recommended continuing aspirin, while 32.5 % actually recommended stopping aspirin [11]. Another study found that only 49.5 % of analyzed patients undergoing endoscopy on antiplatelet or anticoagulant therapy were managed in complete compliance with current antiplatelet/anticoagulant guidelines [12].…”

Section: Discussionmentioning

confidence: 95%

Multimodal intervention for avoiding inappropriate cessation of aspirin prior to outpatient endoscopy

et al. 2020

View full text Add to dashboard Cite

Background and study aims Existing guidelines recommend continuation of aspirin therapy prior to outpatient endoscopic procedures, as it reduces peri-procedural cardiovascular events and is not associated with an increased risk of bleeding. Despite this, many patients at our institution inappropriately alter their aspirin prior to endoscopy. We sought to identify why this occurs and implement an intervention that could reduce improper aspirin alteration. Patients and methods All adult patients undergoing outpatient endoscopy at the Medical University of South Carolina were administered a survey querying demographics, aspirin use, endoscopic procedure, thromboembolic risk factors, and pre-procedural aspirin alteration, if any. An intervention involving revised written and verbal instructions as well as an automated voicemail aimed at ensuring patients adhere to guidelines was then undertaken. The same survey was administered after the intervention to assess for improved adherence. Results A total of 240 patients from the initial survey reported daily aspirin use, of which 114 (47.5 %) inappropriately altered aspirin therapy. A total of 182 patients from the post-intervention survey reported daily aspirin use, of which 66 (36.3 %) inappropriately altered aspirin therapy. This was a statistically significant reduction (P = 0.04), which included adjustments for age, sex, procedure type, and thromboembolic risk. Conclusions A high proportion of patients at our institution inappropriately alter aspirin therapy prior to outpatient endoscopy. The reasons for this behavior include patient self-direction, misguidance from staff, and instruction from other physicians. This alteration can be reduced significantly through an intervention that educates both patients and staff on continuation of aspirin therapy prior to outpatient endoscopy.

show abstract

Anticoagulation Management for Mechanical Valves in the On-X Era

Bethel

Arora

2023

Heart Valves

View full text Add to dashboard Cite

Antiplatelet and anticoagulant drugs management before gastrointestinal endoscopy: Do clinicians adhere to current guidelines?

Cited by 11 publications

References 20 publications

Low molecular weight heparin does not increase bleeding and mortality post‐endoscopic variceal band ligation in cirrhotic patients

Low molecular weight heparin does not increase bleeding and mortality post‐endoscopic variceal band ligation in cirrhotic patients

Multimodal intervention for avoiding inappropriate cessation of aspirin prior to outpatient endoscopy

Anticoagulation Management for Mechanical Valves in the On-X Era

Contact Info

Product

Resources

About