Management of Antithrombotic Agents for Patients Undergoing GI Endoscopy

We recommend that elective endoscopic procedures be deferred until short-term anticoagulation therapy (eg, warfarin for VTE) is completed. (, ⊕⊕⊕o)

We suggest discontinuing anticoagulation (ie, warfarin [Coumadin], NOACs) for the appropriate drug-specific interval in the periendoscopic period if high-risk endoscopic procedures are planned in a patient at low risk for thromboembolic events. (, ⊕⊕oo)

We suggest continuing warfarin and NOAC in the periendoscopic period in patients undergoing low-risk endoscopic procedures. (, ⊕⊕oo)

We suggest bridge therapy for patients undergoing high-risk endoscopic procedures who are at high risk for thromboembolic events. (, ⊕⊕oo)

We suggest that warfarin (Coumadin) be restarted on the same day as the procedure in all patients who do not have ongoing bleeding. (, ⊕⊕oo)

We suggest that the reinitiation of NOACs after high-risk endoscopic procedures be delayed until adequate hemostasis is ensured, given their rapid onset of action and lack of reversal agents. If therapeutic doses of NOACs cannot be restarted within 12 to 24 hours after a high-risk endoscopic procedure, thromboprophylaxis (ie, UFH bridge) should be considered to decrease risk of thromboembolism, given the short half-life of the NOAC agent, in those with a high risk for thromboembolism. (, ⊕⊕oo)

We suggest that continuation of low doses of ASA and nonsteroidal anti-inflammatory drugs may be continued safely in the periendoscopic period. (, ⊕⊕⊕o)

We recommend that thienopyridines be continued for all low-risk endoscopic procedures. (, ⊕⊕⊕o)

We recommend discontinuation of thienopyridines at least 5 to 7 days before high-risk endoscopic procedure or switching to ASA monotherapy and continuing until the thienopyridine can be safely resumed. (, ⊕⊕⊕o)

We recommend that elective endoscopic procedures be deferred in patients with recently placed intracoronary stents and/or ACS until the patient has received antithrombotic therapy for the minimum recommended duration. (, ⊕⊕⊕o)

We suggest that thienopyridines be withheld for at least 5 to 7 days (ticagrelor 3-5 days) before high-risk endoscopic procedures and that ASA be continued for patients requiring dual APA. (, ⊕⊕⊕o)