Hépato-Gastro & Oncologie Digestive
MENUDigestive endoscopy in patients on direct oral anticoagulants and antiplatelet therapy Volume 28, issue 2, Février 2021
- Key words: anti-platelet agents, direct oral anticoagulants, digestive endoscopy, bleeding risk
- DOI : 10.1684/hpg.2021.2133
- Page(s) : 267-74
- Published in: 2021
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).