ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Onboarding (Day One) | March 2023-Mgmt Anti-Thrombotic Agents for GI Endoscopy

Pdf Summary

This document discusses the management of anti-thrombotic agents for patients undergoing gastrointestinal (GI) endoscopy. It highlights the high prevalence of anti-thrombotic use among adults in the US and the increased risk of gastrointestinal bleeding in cardiac patients, particularly those over the age of 75 taking both an anticoagulant and antiplatelet agent. The document emphasizes the need for GI providers to carefully consider the risk vs. benefit of discontinuing anti-thrombotics prior to endoscopy and the importance of multidisciplinary management and guideline-based care.<br /><br />The document provides an overview of the bleeding risk associated with various endoscopic procedures and discusses patient risk factors for bleeding, such as older age, tobacco use, renal insufficiency, and prior gastrointestinal bleeding. It also includes tables that outline the thromboembolic risk assessment tools for patients with atrial fibrillation and the cardio-neurovascular risk associated with different conditions.<br /><br />The document provides a comprehensive list of anti-thrombotic agents, including anticoagulants, antiplatelets, and direct oral anticoagulants (DOACs), and offers guidance on when to stop and resume these medications before and after elective procedures. It also discusses the use of bridging agents and the recommendations for patients on dual anti-platelet therapy (DAPT) undergoing endoscopy.<br /><br />Management strategies for patients with gastro-intestinal bleeding (GIB) and urgent procedures are also discussed, including the identification of life-threatening hemorrhage, the use of reversal agents, and the importance of a multidisciplinary approach.<br /><br />Overall, the document highlights the importance of risk stratification, patient-centered care, and communication between GI providers and prescribing providers in the management of anti-thrombotic agents for patients undergoing GI endoscopy.

Asset Subtitle

Sarah Enslin, PA-C

Keywords

anti-thrombotic agents

gastrointestinal endoscopy

anti-thrombotic use

gastrointestinal bleeding

cardiac patients

anticoagulant

antiplatelet agent

bleeding risk

endoscopic procedures

patient risk factors