ASGE Annual GI Advanced Practice Provider Course - Onboarding Day One (On-Demand) | April 2022-08_Management_Anti-Thrombotic Agents_Pts Undergoing Endo

08_Management_Anti-Thrombotic Agents_Pts Undergoing Endo - Enslin

Pdf Summary

The document discusses the management of antithrombotic agents for patients undergoing GI endoscopy. The objectives of the document include reviewing bleeding risk of endoscopic procedures, cardio-neurovascular risk stratification, and discussing current concepts and best practice principles based on available data/guidelines. The document cites the ACG/CAG Guideline and the ASGE SOP Guideline as sources.<br /><br />The document provides information on the nature of endoscopic procedures and categorizes them based on bleeding risk (high, moderate, low) and cardio-neurovascular risk (high, low). It also discusses different antithrombotic agents, including warfarin, direct acting oral anticoagulants (DOACs), and antiplatelet therapy, and their effects on clotting factors and platelet aggregation.<br /><br />For patients on antithrombotic agents, the document provides recommendations on when to stop these medications before a procedure and when to resume them based on the bleeding risk. It also discusses the management of warfarin with "bridge" therapy and the pharmacodynamics of DOACs compared to warfarin.<br /><br />The document includes guidelines for holding or continuing antithrombotic agents for elective procedures such as diagnostic EGDs, EGD w/dilation, PEG tube placement, push enteroscopy, and ERCP with sphincterotomy. It also emphasizes the importance of a multidisciplinary approach to antithrombotic management, involving gastroenterology, hematology, neurology, cardiology, vascular surgery, oncology, and GI clinic nurse.<br /><br />For patients with gastrointestinal bleeding (GIB) and urgent procedures, the document recommends holding DOACs, reviewing the need for antiplatelet treatment on a case-by-case basis, and consulting with multidisciplinary teams. It also suggests urgent endoscopic evaluation and angiographic embolization when needed, as well as the use of reversal agents for severe or life-threatening bleeding.<br /><br />The document provides management recommendations for warfarin, DOACs, and antiplatelet agents in the setting of major GIB during endoscopy. It also discusses the considerations when a patient is too high risk to stop antithrombotic treatment.<br /><br />Overall, the document highlights the importance of individualized and multidisciplinary approaches for managing antithrombotic agents in patients undergoing GI endoscopy.

Keywords

antithrombotic agents

GI endoscopy

bleeding risk

cardio-neurovascular risk

warfarin

DOACs

antiplatelet therapy

bridge therapy

multidisciplinary approach

gastrointestinal bleeding