PTH-021 A single centre audit of compliance with guidelines for management of anticoagulation and antiplatelet therapy in patients undergoing endoscopic procedures

Abstract

Introduction Patients on anticoagulation and antiplatelet therapy undergoing endoscopic procedures need to be assessed for their risk of bleeding depending on the procedure. BSG guidelines for management of antiplatelet and anticoagulation therapy have standardised the care of patients attending for endoscopy procedures taking Clopidogrel and Warfarin. Newer anticoagulants have been popular among patients and there has been recommendation regarding management of these patients undergoing endoscopic procedures but standard guidelines for this group of patients are still awaited. Method This audit was designed to assess compliance with current guidelines and recommendations for management of patients on antiplatelet and anticoagulation therapy undergoing endoscopic procedures. 50 patients on Clopidogrel, Warfarin and newer anticoagulants undergoing endoscopic procedures has been audited prospectively. Collected data was analysed and compared with guidelines. Results Out of the 50 patients, 23 were taking Warfarin, 17 were on Clopidogrel while 10 were on newer anticoagulants (Dabigatran, Rivaroxaban). 10 patients with warfarin were taking it for Atrial Fibrillation (AF) while 13 had high risk condition (prosthetic heart valves, Venous thromboembolism). 12 of the 17 patients on Clopidogrel had low risk condition while 5 had underlying coronary artery stents. All of the 10 patients with newer anticoagulants had same indication (AF). 19 of the total 50 patients had undergone high risk procedures (10 of them were on warfarin, 6 on Clopidogrel while 3 on newer anticoagulants). Compliance with BSG guidelines has been noted in all patients on Warfarin and Clopidogrel except one patient. We found variability in management of patients on newer anticoagulants probably due to lack of standard guidelines and awareness and in 8 cases out of 10, eGFR (Glomerular Filtration Rate) was not calculated and these medications were not stopped as per recommendation. Conclusion It has been concluded that there has been excellent compliance with guidelines for management of patients on Warfarin and Clopidogrel undergoing endoscopic procedures. We have noted lack of standard guidelines for management of patients on newer anticoagulants and inadequate awareness to current recommendation has effected compliance to the current evidence in this group of patients. We would also like to highlight the importance of calculation of eGFR in decisions of duration of newer anticoagulants to be stopped. Disclosure of interest None Declared.