Clinical Guideline

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1 February 2017

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Gastroscopy and antiplatelet / anticoagulant therapy: Clinical Guideline

British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

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Summary

These guidelines refer to patients undergoing elective endoscopic gastrointestinal procedures. Management of antiplatelet therapy and direct oral anticoagulants (DOACs) in acute gastrointestinal haemorrhage is discussed in detail in ESGE guidelines on the management of acute non-variceal upper gastrointestinal bleeding [1].

Recommendations for the management of patients on antiplatelet therapy or anticoagulants undergoing elective endoscopic procedures are outlined in the algorithms in● ” Fig. 1 and ● ” Fig. 2.

Risk stratification for endoscopic procedures and antiplatelet agents are detailed in● ” Table 1 and● ” Table 2.

There is no high-risk category of thrombosis for DOACs as they are not indicated for prosthetic metal heart valves. Warfarin risk stratification is detailed in● ” Table 3.

Our recommendations are based on best estimates of risk:benefit analysis for thrombosis vs haemorrhage. When discontinuing antithrombotic therapy, patient preference should be considered as well as clinical opinion: the risk of a potentially catastrophic thrombotic event such as a stroke may not be acceptable to a patient even if that risk is very low.

Summary

These guidelines refer to patients undergoing elective endoscopic gastrointestinal procedures. Management of antiplatelet therapy and direct oral anticoagulants (DOACs) in acute gastrointestinal haemorrhage is discussed in detail in ESGE guidelines on the management of acute non-variceal upper gastrointestinal bleeding [1].

Recommendations for the management of patients on antiplatelet therapy or anticoagulants undergoing elective endoscopic procedures are outlined in the algorithms in● ” Fig. 1 and ● ” Fig. 2.

Risk stratification for endoscopic procedures and antiplatelet agents are detailed in● ” Table 1 and● ” Table 2.

There is no high-risk category of thrombosis for DOACs as they are not indicated for prosthetic metal heart valves. Warfarin risk stratification is detailed in● ” Table 3.

Our recommendations are based on best estimates of risk:benefit analysis for thrombosis vs haemorrhage. When discontinuing antithrombotic therapy, patient preference should be considered as well as clinical opinion: the risk of a potentially catastrophic thrombotic event such as a stroke may not be acceptable to a patient even if that risk is very low.

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