Maida M, Sferrazza S, Maida C, Morreale GC, Vitello A, Longo G, Garofalo V, Sinagra E. Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature. World J Gastrointest Endosc 2020; 12(6): 172-192 [PMID: 32843928 DOI: 10.4253/wjge.v12.i6.172]
Corresponding Author of This Article
Marcello Maida, MD, Doctor, Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Via Giacomo Cusmano 1, Caltanissetta 93100, Italy. marcello.maida@hotmail.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jun 16, 2020; 12(6): 172-192 Published online Jun 16, 2020. doi: 10.4253/wjge.v12.i6.172
Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature
Marcello Maida, Sandro Sferrazza, Carlo Maida, Gaetano Cristian Morreale, Alessandro Vitello, Giovanni Longo, Vincenzo Garofalo, Emanuele Sinagra
Marcello Maida, Gaetano Cristian Morreale, Alessandro Vitello, Vincenzo Garofalo, Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta 93100, Italy
Sandro Sferrazza, Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento 38123, Italy
Carlo Maida, U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, University of Palermo, Palermo 93100, Italy
Giovanni Longo, Cardiology Unit, S. Elia-Raimondi Hospital, Caltanissetta 93100, Italy
Emanuele Sinagra, Gastroenterology and Endoscopy Unit, Istituto San Raffaele Giglio, Cefalù 90015, Italy
Author contributions: Maida M, Sferrazza S and Sinagra E are guarantors of the integrity of the entire study and contributed to the manuscript drafting and manuscript revision for relevant intellectual content. All authors contributed to the manuscript editing and had full control over the preparation of the manuscript.
Conflict-of-interest statement: The authors have no proprietary, financial, professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marcello Maida, MD, Doctor, Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Via Giacomo Cusmano 1, Caltanissetta 93100, Italy. marcello.maida@hotmail.it
Received: February 27, 2020 Peer-review started: February 27, 2020 First decision: April 22, 2020 Revised: May 9, 2020 Accepted: May 19, 2020 Article in press: May 19, 2020 Published online: June 16, 2020 Processing time: 110 Days and 14.6 Hours
Abstract
Endoscopic procedures hold a basal risk of bleeding that depends on the type of procedure and patients’ comorbidities. Moreover, they are often performed in patients taking antiplatelet and anticoagulants agents, increasing the potential risk of intraprocedural and delayed bleeding. Even if the interruption of antithrombotic therapies is undoubtful effective in reducing the risk of bleeding, the thromboembolic risk that follows their suspension should not be underestimated. Therefore, it is fundamental for each endoscopist to be aware of the bleeding risk for every procedure, in order to measure the risk-benefit ratio for each patient. Moreover, knowledge of the proper management of antithrombotic agents before endoscopy, as well as the adequate timing for their resumption is essential.
This review aims to analyze current evidence from literature assessing, for each procedure, the basal risk of bleeding and the risk of bleeding in patients taking antithrombotic therapy, as well as to review the recommendation of American society for gastrointestinal endoscopy, European society of gastrointestinal endoscopy, British society of gastroenterology, Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy guidelines for the management of antithrombotic agents in urgent and elective endoscopic procedures.
Core tip: Endoscopic procedures hold a basal risk of bleeding, and they are often performed in patients taking antiplatelet and anticoagulant agents, increasing the potential risk of intraprocedural and delayed bleeding. This review aims to analyze current evidence from literature assessing, for each procedure, the basal bleeding risk and the risk of bleeding in patients taking antithrombotic therapy, as well as to review the recommendation of international guidelines for the management of these agents in urgent and elective endoscopic procedures.
