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

Pdf Summary

This document provides an overview of the management of anti-thrombotic agents for patients undergoing gastrointestinal (GI) endoscopy. It highlights the bleeding risk of endoscopic procedures and reviews patient risk factors for bleeding. The document discusses various anti-thrombotic agents, including anticoagulants and antiplatelets, and emphasizes the importance of following current national guidelines in clinical practice.<br /><br />The document emphasizes the need for a multidisciplinary approach and guideline-based care in managing patients on anti-thrombotic agents. Communication with prescribing providers and informed consent are also crucial.<br /><br />It lists different endoscopy procedures and categorizes them as high or low bleeding risk. The risk assessment also includes assessing cardiovascular and neurological risks, such as stroke risk evaluation in patients with atrial fibrillation.<br /><br />Patient risk factors for bleeding are discussed, including older age, tobacco use, obstructive sleep apnea, male gender, renal insufficiency, prior gastrointestinal bleeding, and NSAID use.<br /><br />The document highlights the role of advanced practice providers (APPs) in patient procedure preparation, following guideline-based protocols, and ensuring patient safety.<br /><br />Specific recommendations are provided for different anti-thrombotic agents, including warfarin, direct oral anticoagulants (DOACs), and antiplatelet agents. Guidelines for holding and resuming these agents before and after procedures are discussed.<br /><br />The document also addresses the management of patients with acute gastrointestinal bleeding and urgent procedures, emphasizing the identification of life-threatening hemorrhage, resuscitation protocols, urgent endoscopic evaluation, and reversal agents.<br /><br />Practice pearls include risk stratification, deferring elective procedures in high-risk patients, continuation of aspirin for secondary cardiovascular prophylaxis, and multidisciplinary patient-centered care.<br /><br />Polling questions at the end of the document test the reader's understanding of the content.

Asset Subtitle

Sarah Enslin, PA-C

Keywords

management

anti-thrombotic agents

gastrointestinal endoscopy

bleeding risk

patient risk factors

anticoagulants

antiplatelets

national guidelines

multidisciplinary approach

guideline-based care