Antithrombotic therapy and digestive endoscopy: a difficult management.

Abstract

Antithrombotic therapy (antiplatelet and anticoagulant) is frequently used in clinical practice for the prevention of thromboembolic events in patients at risk, such as those with atrial fibrillation or pro-thrombotic conditions. On the other hand, endoscopic investigations on the upper digestive tract (gastroscopy, endoscopic retrograde colangiopancreatography) and lower (colonoscopy) are increasingly performed to prevent, diagnose and treat different diseases of digestive tract. Therefore, it is not uncommon for a patient to undergo endoscopic examination while taking antithrombotic therapy. The pharmacological management of these patients requires a careful balance between the haemorrhagic risk linked to the continuation of therapy and the hemorrhagic risk inherent to the endoscopic procedure, particularly when an operative procedure (polypectomy, sphincterotomy, etc.) is required. Beyond classical anticoagulants (vitamin K antagonists, dicumarolici), the so-called "direct-acting anticoagulants" have been recently introduced, and management of these drugs in before an endoscopic examination is different. Since endoscopic procedures are largely scheduled as "open access" directly by general practitioner, she/he is clearly involved in the management of these patients. This review aims to report the recommendations of international guidelines on this field, and to provide some schematic tools for performing a correct management of patients on antithrombotic therapy before gastrointestinal endoscopy.