According to a new guideline from the American Society for Gastrointestinal Endoscopy (ASGE) regarding the management of antithrombotic agents for endoscopy, the organization says aspirin and/or NSAIDs may be continued for all elective endoscopic procedures.
When high-risk procedures are planned, clinicians may elect to discontinue aspirin and/or NSAIDs for five to seven days before the procedure, depending on the underlying indication for antiplatelet therapy. For patients on temporary anticoagulation therapy (e.g., warfarin for deep venous thrombosis), it is suggested that elective endoscopic procedures be deferred until antithrombotic therapy is completed.
The guideline, “Management of antithrombotic agents for endoscopic procedures,” was developed by ASGE's Standards of Practice Committee and appears in the December issue of GIE: Gastrointestinal Endoscopy.
Antithrombotic agents include anticoagulants (e.g., warfarin, heparin, and low molecular weight heparin) and antiplatelet agents (e.g., aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), thienopyridines (e.g., clopidrogrel and ticlopidine), and glycoprotein IIb/IIIa receptor inhibitors.
Antithrombotic therapy is used to reduce the risk of thromboembolic events (blocking of a blood vessel by a blood clot dislodged from its site of origin) in patients with certain cardiovascular conditions (e.g., atrial fibrillation and acute coronary syndrome), deep venous thrombosis (DVT), hypercoagulable states and endoprostheses. The most common site of significant bleeding in patients receiving oral anticoagulation therapy is the gastrointestinal (GI) tract.
Potential thromboembolic events that may occur with the withdrawal of medication can be devastating, whereas bleeding after high-risk procedures, although increased in frequency, is often not associated with any significant morbidity or mortality. Discussion with the patient and his or her prescribing physician before the procedure is invaluable to help determine whether antithrombotic agents should be stopped or adjusted in any particular patient.
This guideline is an update of two previous ASGE guidelines and addresses the management of patients undergoing endoscopic procedures who are receiving antithrombotic therapy, providing recommendations and management algorithms.
More information about these guidelines are available by clicking here.