Hôpital Avicenne (AP-HP), Université Sorbonne Paris Nord, Service de Gastroentérologie et Oncologie Digestive, 93000 Bobigny
Hôpital Saint-Joseph, Service de Gastroentérologie et d’Explorations digestives, 13008 Marseille
Management of patients on antiplatelet therapy or direct oral anticoagulants undergoing elective digestive endoscopy procedures relies on the knowledge of bleeding risk stratification of endoscopic procedures and modalities for discontinuation of antithrombotic agents when justified. Diagnostic procedures are associated with a low bleeding risk and can be performed without change in antithrombotic treatment. However, most therapeutic procedures (including resection, fine needle aspiration, dilation, stenting) are associated with a high bleeding risk of bleeding and require discontinuation of anticoagulants and most of antiplatelet agents except low-dose aspirin which should always be continued to prevent coronary stent thrombosis. Contrary to vitamin K antagonists, there is no need for any biological monitoring or bridging therapy with low molecular weight heparin when using direct oral anticoagulants. Recent guidelines have given direction in the discontinuation and subsequent restart of antithrombotic agents, depending on the patient's individual thrombotic risk, treatment's length of action and bleeding risk stratification of endoscopic procedures. Patient information, traceability of treatment modification recommendations, and post-endoscopy surveillance are mandatory to avoid bleeding complications (mostly delayed post-polypectomy bleeding) or major adverse cardiovascular events (related to unjustified or prolonged antithrombotic treatment discontinuation).