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Therapy Insight: approaching endoscopy in anticoagulated patients

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 43–52 (2006)Cite this article

Abstract

Over the past decade, the application of anticoagulant and antiplatelet agents for various cardiovascular and hematologic conditions has become more widespread. Optimal management of these agents during the periendoscopic period requires consideration, but limited prospective data mean that guidelines have largely relied on expert opinion. Elective procedures should be delayed in patients on temporary anticoagulation therapy (e.g. those with deep vein thrombosis). For procedures considered to have a low risk of bleeding (e.g. diagnostic endoscopy and colonoscopy without polypectomy) there is no need to discontinue or adjust anticoagulation. For procedures with a higher risk of bleeding (e.g. polypectomy and biliary sphincterotomy) an individual approach is required. This approach might include stopping oral anticoagulant therapy with or without the administration of unfractionated heparin or low-molecular-weight heparin for the preprocedure and postprocedure periods, during which the patient's international normalized ratio is in the subtherapeutic range.

Key Points

  • There are limited data to guide appropriate management of anticoagulation in the periendoscopic period

  • Low-bleeding-risk procedures can be performed without adjusting anticoagulation or antiplatelet therapy

  • High-bleeding-risk procedures might require cessation of oral anticoagulant therapy with the option of heparin bridging therapy, depending on the patient's thromboembolic risk

  • Although antiplatelet therapy can be withheld for high-bleeding-risk procedures, there is insufficient evidence to indicate that bleeding risk is impacted

  • Consultation with the patient's primary care physician, hematologist or cardiologist might be necessary to develop an optimal management strategy for complex cases

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Figure 1: Approach to the anticoagulated patient during elective endoscopic procedures.

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Author information

Authors and Affiliations

  1. Fellow Gastroenterology Division and Director of Endoscopic Services at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    George A Makar

  2. Professor of Medicine in the Gastroenterology Division and Director of Endoscopic Services at the Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Gregory G Ginsberg

Authors
  1. George A Makar
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  2. Gregory G Ginsberg
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Correspondence to George A Makar or Gregory G Ginsberg.

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The authors declare no competing financial interests.

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Makar, G., Ginsberg, G. Therapy Insight: approaching endoscopy in anticoagulated patients. Nat Rev Gastroenterol Hepatol 3, 43–52 (2006). https://doi.org/10.1038/ncpgasthep0387

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