Abstract
The use of direct oral anticoagulants (DOAC) for the treatment of atrial fibrillation and prevention of strokes is encouraged by their superior properties compared to vitamin K antagonists: predictable anticoagulant effect, greater patient compliance, few drug interactions, low risk of intracranial hemorrhages. Although practicing gastroenterologists may never prescribe a DOAC, they are likely to encounter DOAC-related GI adverse events (gastrointestinal bleeding), and they will need to manage DOACs around the time of endoscopy. The present paper aims to present the management possibilities of the patient treated with DOAC undergoing endoscopy, most studies performed so far focusing on the risk of spontaneous bleeding in this category of subjects. The current guidelines provided by the British Society of Gastroenterology and the European Society of Gastrointestinal Endoscopy orientate us, but endoscopic maneuvers should be preceded by a detailed analysis of the risks of secondary bleeding and thrombosis associated with DOAC users.
Highlights
The use of direct oral anticoagulants (DOAC) for the treatment of atrial fibrillation and prevention of strokes is encouraged by their superior properties compared to vitamin K antagonists: predictable anticoagulant effect, greater patient compliance, few drug interactions, low risk of intracranial hemorrhages
There is an increasingly number of studies related to the risk of hemorrhage secondary to an endoscopic gesture in patients treated with DOAC, respectively to the thrombotic risk that may occur by short-term anticoagulant cessation in order to perform an urgent or an elective endoscopic maneuver
The recommendation of the British Society of Gastroenterology and the European Society of Gastrointestinal Endoscopy is to administer the last dose of DOAC at least 48 hours before a high-risk endoscopic procedure; for patients treated with dabigatran, the measurement of the glomerular filtration rate is mandatory to decide the optimal time to discontinue DOAC5
Summary
The use of direct oral anticoagulants (DOAC) for the treatment of atrial fibrillation and prevention of strokes is encouraged by their superior properties compared to vitamin K antagonists: predictable anticoagulant effect, greater patient compliance, few drug interactions, low risk of intracranial hemorrhages. There is an increasingly number of studies related to the risk of hemorrhage secondary to an endoscopic gesture in patients treated with DOAC, respectively to the thrombotic risk that may occur by short-term anticoagulant cessation in order to perform an urgent or an elective endoscopic maneuver.
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