Designed and created by Guideline Central in participation with the American College of Gastroenterology
Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period
Patient Guideline Summary
Publication Date: March 17, 2022
Objective
Objective
This patient summary means to summarize key recommendations from the American College of Gastroenterology (ACG) and the Canadian Association of Gastroenterology for management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. This patient summary is limited to adults 18 years of age and older and should not be used as a reference for children.
Overview
Overview
- Antithrombotic drugs are used in the management of many heart and vascular diseases, but they increase the risk of gastrointestinal (GI) bleeding from sources such as ulcers and diverticula (abnormal pieces of bowel) and from endoscopic procedures.
- The goal of management during GI bleeds and during endoscopy is to balance the risk of bleeding against the risk from the cardiovascular disease being treated with these medications.
Management
Management
Blood clotting is a complicated series of events that can be moderated in several different ways.
- Antithrombotic drugs include:
- vitamin K antagonists (VKAs). For example: warfarin and acenocoumarol.
- direct oral anticoagulants (DOACs). For example, apixaban, dabigatran, edoxaban, and rivaroxaban.
- antiplatelet drugs such as the P2Y12 receptor inhibitors (clopidogrel, prasugrel, and ticagrelor), and acetylsalicylic acid (aspirin/ASA)
- Treatments that reverse one or more of the above drugs include:
- Vitamin K reverses VKAs
- Drugs designed to counteract other drugs (idarucizumab (Praxbind®) reverses dabigatran, andexanet alfa (Andexxa®) reverses apixaban and rivaroxaban
- Transfusion of selected blood products:
- Fresh frozen plasma (FFP) reverses VKAs
- Prothrombin complex concentrate (PCC) reverses VKAs and DOACs
- Platelets reverse antiplatelet drugs
- The ACG makes separate recommendations for gastrointestinal (GI) bleeding and for endoscopy.
- Recommendations for patients undergoing endoscopy involve either:
- Temporarily interrupting the drug or
- Continuing the drug or
- Substituting a different drug.
- Recommendations for patients with a GI bleed vary with the drug in question, either temporarily interrupting the drug or reversing the drug with one of the methods listed above.
- Recommendations for patients undergoing endoscopy involve either:
- Recommendations often include a duration for temporary changes.
- For some treatments the AGA did not have enough evidence to make a recommendation.
Abbreviations
- ACG: American College Of Gastroenterology
- ASA: Acetylsalicylic Acid
- DOACs: Direct Oral Anticoagulants
- FFP: Fresh Frozen Plasma
- GI: Gastrointestinal
- PCC: Prothrombin Complex Concentrates
- VKAs: Vitamin K Antagonists
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
doi: 10.14309/ajg.0000000000001627
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.