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Endoscopy in the patient on antithrombotic therapy

Abu Daya, Hussein; Younan, Lara; Sharara, Ala I.

Current Opinion in Gastroenterology: September 2012 - Volume 28 - Issue 5 - p 432–441
doi: 10.1097/MOG.0b013e328355e26f
ENDOSCOPY: Edited by Anthony N. Kalloo

Purpose of review The management of antithrombotics during the periendoscopic period is a common clinical problem. This review focuses on recent literature addressing this issue, primarily on articles published from 2009 to 2012.

Recent findings A large proportion of the studies retrieved focused on the effect of antithrombotics on bleeding risk following diagnostic endoscopy, polypectomy, endoscopic mucosal resection, and submucosal dissection, whereas studies involving other endoscopic procedures were scarce. Recent American and European guidelines direct the management of antithrombotic therapy in patients undergoing endoscopy according to the procedure's risk of bleeding and the patient's thromboembolic risk. The difficulty in determining a priori the need for endotherapy and hence appropriate classification of risk of bleeding prior to the procedure is a potential limitation of such classification. Moreover, most studies have primarily addressed the risk of immediate or early bleeding by proposing interruption of antithrombotic therapy prior to endotherapy, and few have focused on the risk of delayed bleeding and the optimal time for resumption of these agents following high-risk procedures.

Summary Management of patients on antithrombotics remains complex, especially in high-risk settings. Existing guidelines are valuable but should not be a substitute for a careful personalized risk assessment strategy involving patient and physician.

Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

Correspondence to Ala I. Sharara, MD, FACG, AGAF, Professor and Head, Division of Gastroenterology American University of Beirut Medical Center, P.O. Box 11–0236/16-B, Beirut, Lebanon. Tel: +961 1 350000/5351; fax: +961 1 366098; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.