Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period
Publication Date: March 17, 2022
VKA reversal
For patients on warfarin who are hospitalized or under observation with acute GI bleeding, we suggest against fresh frozen plasma (FFP) administration. (C, VL)
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For patients on warfarin who are hospitalized or under observation with acute GI bleeding, we could not reach a recommendation for or against prothrombin complex concentrate administration. (U, U)
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For patients on warfarin who are hospitalized or under observation with acute GI bleeding, we suggest prothrombin complex concentrate administration compared with FFP administration. (C, VL)
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For patients on warfarin who are hospitalized or under observation with acute GI bleeding, we suggest against the use of vitamin K. (C, VL)
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Direct thrombin inhibitor reversal
For patients on dabigatran who are hospitalized or under observation with acute GI bleeding, we suggest against the administration of idarucizumab. (C, VL)
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Reversal of rivaroxaban or apixaban with andexanet alfa
For patients on rivaroxaban or apixaban who are hospitalized or under observation with acute GI bleeding, we suggest against andexanet alfa administration. (C, VL)
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Reversal of DOACs with PCC
For patients on direct oral anticoagulants who are hospitalized or under observation with acute GI bleeding, we suggest against prothrombin complex concentrate administration. (C, VL)
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Reversal of antiplatelet with platelet transfusion
For patients on antiplatelet agents who are hospitalized or under observation with acute GI bleeding, we suggest against platelet transfusions. (C, VL)
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Holding ASA vs continuing ASA
For patients with GI bleeding on cardiac ASA for secondary cardiovascular prevention, we suggest against holding the ASA. (C, VL)
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For patients with GI bleeding on ASA for secondary cardiovascular prevention whose ASA was interrupted, we suggest the ASA be resumed on the day hemostasis is endoscopically confirmed. (C, VL)
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Anticoagulant interruption vs continuation
For patients on warfarin undergoing elective/planned endoscopic GI procedures, we suggest warfarin be continued, as opposed to temporarily interrupted (1–7 days). (C, VL)
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For patients on warfarin, who hold warfarin in the periprocedural period for elective/planned endoscopic GI procedures, we suggest against bridging anticoagulation. (C, L)
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For patients on direct oral anticoagulants (DOACs) who are undergoing elective/planned endoscopic GI procedures, we suggest temporarily interrupting DOACs rather than continuing DOACs. (C, VL)
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Antiplatelet interruption vs continuation
For patients on dual antiplatelet therapy for secondary cardiovascular prevention who are undergoing elective endoscopic GI procedures, we suggest temporary interruption of the P2Y12 inhibitor while continuing ASA. (C, VL)
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For patients on single antiplatelet therapy with P2Y12 inhibitor agents who are undergoing elective endoscopic GI procedures, we could not reach a recommendation for or against temporary interruption of the P2Y12 inhibitor. (U, U)
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For patients on ASA 81–325 mg/d (monotherapy) for secondary cardiovascular prevention, we suggest against interruption of ASA. (C, VL)
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In patients who are undergoing elective endoscopic GI procedures whose warfarin was interrupted, we could not reach a recommendation for or against resuming warfarin the same day vs 1–7 days after the procedure. (U, U)
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In patients who are undergoing elective endoscopic GI procedures whose DOAC was interrupted, we could not reach a recommendation for or against resuming the DOAC on the same day of the procedure vs 1–7 days after the procedure. (U, U)
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Timing of P2Y12 inhibitor resumption after endoscopy
In patients who are undergoing elective endoscopic GI procedures whose P2Y12 inhibitor was interrupted, we could not reach a recommendation for or against resuming P2Y12 inhibitor on the same day of the procedure vs 1–7 days after the procedure. (U, U)
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Title
Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period
Authoring Organization
American College of Gastroenterology
Publication Month/Year
March 17, 2022
Country of Publication
US
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Outpatient, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Prevention
Diseases/Conditions (MeSH)
D000925 - Anticoagulants, D006471 - Gastrointestinal Hemorrhage, D000980 - Antiplatyhelmintic Agents
Keywords
Upper Gastrointestinal bleeding, gastrointestinal bleeding, anticoagulants, antiplatelets
Source Citation
Abraham, Neena S. MD, MSc (Epi), FACG1; Barkun, Alan N. MD, MSc (Epi), FACG, CAGF2; Sauer, Bryan G. MD, MSc (Clin Res), FACG3; Douketis, James MD4; Laine, Loren MD, FACG5,6; Noseworthy, Peter A. MD7; Telford, Jennifer J. MD, MPH, FACG, CAGF8; Leontiadis, Grigorios I. MD, PhD, CAGF9 American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period, The American Journal of Gastroenterology: March 17, 2022 - Volume - Issue - 10.14309/ajg.0000000000001627
doi: 10.14309/ajg.0000000000001627
Methodology
Number of Source Documents
100
Literature Search Start Date
January 1, 1985
Literature Search End Date
August 13, 2020