Anti-platelet/Anti-coagulants in Endoscopy

                             Antiplatelet agents

Continuing Aspirin for all endoscopic procedures with the exception of

  • – ESD
  • – Large colonic EMR (> 2 cm)
  • – Upper GI EMR
  • – Ampullectomy

In the latter cases, aspirin should be considered on an individual patient basis depending on the risks of thrombosis vs haemorrhage

 

  • High -risk endoscopic procedures + low thrombotic risk
  •            – Discontinuing clopidogrel 5 days before the procedure
  •            – Continuing aspirin in discontinuation case of dual antiplatelet therapy
  • High-risk endoscopic procedures + high thrombotic risk
  •            – Continuing aspirin and consult with a cardiologist about the risk/benefit of discontinuing clopidogrel

                     

 

                                 High -risk procedure

  • High -risk endoscopic procedures + Low thrombotic risk
  •             – Continuing aspirin in case of dual antiplatelet therapy
  •             – Discontinue clopidogrel 5 days before the procedure
  •             – Discontinue warfarin 5 days before the procedure
  •             – Check INR prior to the procedure to ensure this value is < 1.5
  •             – On the day of the procedure, restart warfarin with the usual daily dose that night
  •             – Check INR 1 week later to ensure adequate anticoagulation

 

  • High -risk endoscopic procedures + High thrombotic risk
  •             – Continue aspirin and consult with a cardiologist about the risk/ benefit of discontinuing clopidogrel
  •             – Discontinue warfarin temporarily and substitute with LMW heparin
  •             – Stop warfarin 5 days before the procedure
  •             – 2 days after stopping warfarin, commence daily therapeutic dose of LMWH
  •             – Administer the last dose of LM WH at least 24 hours prior to the procedure
  •             – Check the INR prior to the procedure to ensure its value is < 1.5
  •             – Warfarin can be resumed on the day of the procedure with the usual dose that night
  •             – Restart the daily therapeutic dose of LM WH on the day after the procedure
  •             – Continue LM WH until a satisfactory INR is achieved

 

 

 

 


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