Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature

Abstract

Endoscopic procedures hold a basal risk of bleeding that depends on the type of procedure and patients’ comorbidities. Moreover, they are often performed in patients taking antiplatelet and anticoagulants agents, increasing the potential risk of intraprocedural and delayed bleeding. Even if the interruption of antithrombotic therapies is undoubtful effective in reducing the risk of bleeding, the thromboembolic risk that follows their suspension should not be underestimated. Therefore, it is fundamental for each endoscopist to be aware of the bleeding risk for every procedure, in order to measure the risk-benefit ratio for each patient. Moreover, knowledge of the proper management of antithrombotic agents before endoscopy, as well as the adequate timing for their resumption is essential. This review aims to analyze current evidence from literature assessing, for each procedure, the basal risk of bleeding and the risk of bleeding in patients taking antithrombotic therapy, as well as to review the recommendation of American society for gastrointestinal endoscopy, European society of gastrointestinal endoscopy, British society of gastroenterology, Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy guidelines for the management of antithrombotic agents in urgent and elective endoscopic procedures.

Green endoscopy, one step toward a sustainable future: Literature review

“…First, instructions on diet and bowel preparation must be provided in written form, the solution for preparation must be chosen among those recommended by the guidelines, performed in a split fashion, and colonoscopy must performed within 5 hours following bowel preparation [48][49]. Furthermore, at the preliminary colonoscopy interview, the concomitant therapy must be investigated, and the possible intake of antiplatelet and/or anticoagulant drugs managed preventively in accordance with the guidelines [50].…”