Management Of Therapy of Anticoagulants and Antiplatelets in Acute Gastrointestinal Bleeding and In the Periendoscopic Period

Abstract

Management of anticoagulant and antiplatelet therapy is a common clinical problem in case of urgent or elective gastrointestinal endoscopic procedures. Anticoagulants and antiplatelet agents are widely used drugs for cardiovascular prevention and reducing the risk of thromboembolic events. Gastrointestinal bleeding represents a serious complication of their use. It’s recommended temporary interruption of anticoagulants in clinically significant gastrointestinal bleeding. For the antiplatelet therapy the decision is when to stop and restart the therapy, depending on whether it’s for primary or secondary cardiovascular prevention. Treatment with antithrombotic drugs in the periprocedural endoscopic period is based on balancing the bleeding risk against the thromboembolic risk. It’s recommended temporary discontinuation of antithrombotic treatment in high-risk endoscopic procedures with high risk for bleeding and to consider the use of “bridging” therapy with LWMH for patients on vitamin K antagonists who are at high thrombotic risk. Antithrombotic agents in endoscopic procedures with lower bleeding risk are not needed to be withheld. Evaluating cardiovascular risk and management of antithrombotic therapy could be a challenge for gastrointestinal endoscopists, therefore collaboration with a cardiologist is of great importance, at least for some patients.