Vitamine K Antagonist and Colonoscopy: Proposal to Get out of a Dilemma

Abstract

The management of anticoagulants in patients requiring digestive endoscopy, and particularly VKA, is not always easy. There is indeed often a discrepancy between the recommendations of leaned societies and practice in the conduct of VKA treatment before a screening colonoscopy. The recommendations take into account the haemorrhagic risk of the endoscopic procedure and the nature and importance of the thrombotic risk for which the patient is under treatment. A colonoscopy with or without a biopsy is considered a low bleeding risk procedure for which it is recommended not to stop VKA treatment. If the examination reveals a lesion, the resection gesture will be programmed in a second time after stopping the AVK which will possibly be substituted by a Low molecular weight heparin according to a very precise schedule. In practice, this recommendation is poorly followed, because the continuation of VKA does not allow to carry out simultaneously a diagnostic and therapeutic gesture and sometimes imposes an overload of work. Its systematic stopping is also not the right solution, because it often consists of unnecessary thromboembolic risk taking. To resolve this dilemma, we propose to decide whether to discontinue VKA treatment based on the level of risk of adenoma and colorectal cancer.