ASGE Advanced Endoscopic Lesion Resection Course (On-Demand) | November 2022-14 Sinha

14 Sinha_Management of Anti-Thrombotic Therapy

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This document summarizes the content discussed in a presentation titled "Managing Anti-Thrombotic Therapy" by Jasmine Sinha, MD MPH. The objective of the presentation was to discuss various aspects of antiplatelet and anticoagulant therapy and their management in the context of gastrointestinal procedures.<br /><br />The presentation covered the mechanism and pharmacokinetics of antiplatelet drugs, including aspirin and clopidogrel. It highlighted the increased risk of post-polypectomy bleeding (PPB) associated with these medications, with a particular emphasis on the delayed risk with clopidogrel. The presentation also mentioned the risk of cardiac events if aspirin is discontinued in patients with established cardiovascular disease or high cardiovascular risk.<br /><br />Regarding anticoagulant therapy, the presentation discussed the increased risk of PPB in patients on anticoagulation compared to controls. However, it noted that continuation of warfarin without interruption was non-inferior in terms of bleeding risk in several studies. The use of heparin bridge therapy was associated with higher rates of PPB.<br /><br />The presentation also provided recommendations for managing antiplatelet and anticoagulant therapy during elective endoscopy procedures. It suggested holding antiplatelet therapy for patients on dual antiplatelet therapy and for those with high-risk features. It recommended against heparin bridge therapy and advised holding direct oral anticoagulants (DOACs) prior to elective endoscopy.<br /><br />Finally, the presentation briefly mentioned the reversal therapy for both antiplatelet and anticoagulant therapy. It recommended against using platelet transfusion for antiplatelet therapy reversal and highlighted the lack of consensus on the use of fresh frozen plasma and vitamin K for warfarin reversal. It also noted that reversal agents for DOACs have short half-lives and their use is not recommended.<br /><br />Overall, the presentation provided a comprehensive overview of the management of anti-thrombotic therapy in the context of gastrointestinal procedures.

Keywords

Managing Anti-Thrombotic Therapy

Jasmine Sinha

antiplatelet drugs

anticoagulant therapy

gastrointestinal procedures

post-polypectomy bleeding

aspirin

clopidogrel

warfarin

elective endoscopy procedures