ENDO Hangout for GI Fellows - Practical Approach in the Management of Anticoagulation in the Setting of GI Bleeding | November 2022-Practical Approach in the Management of Anticoagulation in the Setting of GI Bleeding

Video Transcription

Video Summary

The video discusses the management of anticoagulation and antiplatelet therapy in the setting of gastrointestinal bleeding and elective endoscopic procedures. The presenters emphasize the importance of determining whether a bleed is life-threatening based on specific criteria, such as severe hypotension or significant decrease in hemoglobin levels. They recommend the use of prothrombin complex concentrate (PCC) for the management of warfarin-associated bleeding, as it is rapid and reliable in correcting the INR. For patients on direct-acting oral anticoagulants (DOACs), the presenters advise against routine reversal agents and discuss the appropriate timing of their interruption prior to procedures, based on the type of procedure and the type of stent the patient has. In the elective endoscopic period, they provide guidelines for the management of antiplatelet agents, such as aspirin and clopidogrel, and recommend continuing aspirin while temporarily holding clopidogrel. They also discuss the management of anticoagulation with warfarin in the peri-endoscopic period, recommending different approaches based on the bleeding risk of the procedure. Finally, they address the use of bridging therapy for patients on warfarin, emphasizing that routine bridging is not necessary and should only be considered in certain high-risk patients. Overall, the presenters provide practical guidance for the management of anticoagulation and antiplatelet therapy in the context of gastrointestinal bleeding and elective endoscopic procedures.

Keywords

anticoagulation

antiplatelet therapy

gastrointestinal bleeding

endoscopic procedures

prothrombin complex concentrate

direct-acting oral anticoagulants

reversal agents

interrupting anticoagulation

bridging therapy