GI Unit Leadership: Optimizing Endoscopy Operations through Leadership (Virtual) | February 2025-ASGE guideline

ASGE guideline_antithrombotic management

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The document outlines guidelines from the American Society for Gastrointestinal Endoscopy (ASGE) concerning the management of antithrombotic agents in patients undergoing gastrointestinal (GI) endoscopic procedures. Antithrombotic agents, including anticoagulants and antiplatelet agents, are used to reduce the risk of thromboembolic events in conditions like atrial fibrillation, acute coronary syndrome, and deep vein thrombosis. These medications, while essential for preventing serious conditions, can increase the risk of bleeding, particularly during endoscopic procedures.<br /><br />The guidelines emphasize assessing multiple factors when planning endoscopy on patients on antithrombotic therapy, such as the urgency of the procedure, the procedure's bleeding risk, the impact of the medication on bleeding risk, and the risk of thromboembolic events if such medications are interrupted. For instance, specific endoscopic procedures vary in their potential to cause bleeding, and their risk levels are categorized to guide decisions around the management of antithrombotic therapy.<br /><br />In elective procedures, guidelines suggest delaying endoscopy if feasible until antithrombotic therapy is no longer necessary. If this is impossible, medications may be stopped, switched, or continued based on individual patient risk assessment. The document provides specific recommendations for different drugs and scenarios, such as continuing low-dose aspirin for many procedures, stopping warfarin or newer oral anticoagulants where high bleeding risk exists, and carefully managing dual antiplatelet therapy, particularly following the placement of coronary stents.<br /><br />Urgent endoscopies require holding or reversing antithrombotic agents to allow for effective hemostasis during bleeding events. Restarting any antithrombotic therapy post-procedure should be based on the balance between maintaining hemostasis and preventing thromboembolic events.<br /><br />This guideline serves as an educational resource, aiming to guide endoscopists in making informed clinical decisions rather than establishing rigid legal standards. It acknowledges the need for further studies to clarify aspects of antithrombotic management in endoscopic procedures, accommodating potential updates with emerging data and technological advancements.

Keywords

ASGE guidelines

antithrombotic agents

gastrointestinal endoscopy

bleeding risk

thromboembolic events

anticoagulants

antiplatelet therapy

endoscopic procedures

hemostasis

clinical decision-making