Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage versus thrombosis due to discontinuation of therapy. P2Y12 receptor antagonists (clopidogrel, prasugrel, ticagrelor) For low-risk endoscopic procedures we recommend continuing P2Y12 receptor antagonists as single or dual antiplatelet therapy (low quality evidence, strong recommendation); For high-risk endoscopic procedures in patients at low thrombotic risk, we recommend discontinuing P2Y12 receptor antagonists five days before the procedure (moderate quality evidence, strong recommendation). In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation). For high-risk endoscopic procedures in patients at high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor antagonists (high quality evidence, strong recommendation). Warfarin The advice for warfarin is fundamentally unchanged from British Society of Gastroenterology (BSG) 2008 guidance. Direct Oral Anticoagulants (DOAC) For low-risk endoscopic procedures we suggest omitting the morning dose of DOAC on the day of the procedure (very low quality evidence, weak recommendation); For high-risk endoscopic procedures, we recommend that the last dose of DOAC be taken ≥48 h before the procedure (very low quality evidence, strong recommendation). For patients on dabigatran with CrCl (...
Source: Gut - Category: Gastroenterology Authors: Tags: Endoscopy, Open access Guidelines Source Type: research

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AbstractIntroductionVenous thromboembolism (VTE) is a significant cause of morbidity and mortality after bariatric surgery. Roughly 80% of VTEs occur post-discharge. The frequency of post-discharge heparin (PDH) prophylaxis use is unknown, and evidence about benefits and risks is limited. We aimed to determine the rate of use of PDH prophylaxis and evaluate its relationship with VTE and bleeding events.MethodsUsing the Truven Health MarketScan ® database, we performed a retrospective cohort study (2007–2015) of adult patients who underwent sleeve gastrectomy or gastric bypass. We determined PDH prophylaxis from o...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
This study utilizes the Veterans Affairs Surgical Quality Improvement Program database to examine the status and outcome of cholecystectomy.MethodsA retrospective review of veterans who underwent cholecystectomy between 2008 and 2015 was performed. Data analysis included patient demographics, operations, and postoperative outcomes. Cochran-Armitage trend analysis was used to assess significant changes in outcome over the study period.p ≤ 0.05 was considered significant.ResultsA total of 40,722 patients (average age of 61  years) were included in the study (males 85.6%). LC was performed in the majorit...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
CONCLUSION: The risk of CVD was greater in G6PD-deficient subjects after age 60, both in males and females, than those with normal enzyme activity, after adjusting for conventional CVD risk factors and H. pylori infection. The reduction of important protective mechanisms against oxidative stress in elderly might explain the study findings. PMID: 32908034 [PubMed - as supplied by publisher]
Source: Journal of Atherosclerosis and Thrombosis - Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
ConclusionsBariatric surgery can be safely performed in patients on therapeutic anticoagulation, though this population is at greater risk for bleeding complications in the perioperative period. Meticulous hemostasis in the operating room is the most important aspect of preventing bleeding complications.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
Endoscopy DOI: 10.1055/a-1230-3357 Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, GermanyArticle in Thieme eJournals: Table of contents  |  Full text
Source: Endoscopy - Category: Gastroenterology Authors: Tags: E-Videos Source Type: research
We read with great interest the article by Tien et  al.1 The authors presented some new findings indicating that direct oral anticoagulants (DOAC) did not increase the risk of postendoscopic GI bleeding and thromboembolic (TE) events when compared with warfarin, as per the data of a large integrated healthcare system. Endoscopists need to continual ly strike a balance between bleeding and thromboembolism in patients taking anticoagulants. Notably, this research provided evidence for endoscopists regarding anticoagulant management in the preoperative stage, especially for DOAC.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Letter to the Editor Source Type: research
AbstractObjectivesTo assess the hypothesis that an adjunctive therapy with methylprednisolone and unfractionated heparin (UFH) or with methylprednisolone and low molecular weight heparin (LMWH) are more effective in reducing any-cause mortality in critically-ill ventilated patients with pneumonia from SARS-CoV-2 infection compared to LMWH alone.Trial designThe study is designed as a multi-centre, interventional, parallel group, superiority, randomized, investigator sponsored, three arms study. Patients, who satisfy all inclusion criteria and no exclusion criteria, will be randomly assigned to one of the three treatment gro...
Source: Trials - Category: Research Source Type: clinical trials
The aging of the population has resulted in atrial fibrillation (AF) becoming increasingly prevalent. Treatment focuses on the prevention of thromboembolism through the use of catheter ablation or drug therapy with anticoagulants, such as warfarin or direct oral anticoagulants (DOACs). Dabigatran-induced exfoliative esophagitis has been reported as a rare side effect of DOACs. Although most cases are mild, some result in severe outcomes. However, the etiology of exfoliative esophagitis remains incompletely understood. The aim of this study is to investigate the etiology of exfoliative esophagitis and identify its risk fact...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
AbstractObjectivesTo assess whether high doses of Low Molecular Weight Heparin (LMWH) (i.e. Enoxaparin 70 IU/kg twice daily) compared to standard prophylactic dose (i.e., Enoxaparin 4000 IU once day), in hospitalized patients with COVID19 not requiring Invasive Mechanical Ventilation [IMV], are:more effective in preventing clinical worsening, defined as the occurrence of at least one of the following events, whichever comes first:DeathAcute Myocardial Infarction [AMI]Objectively confirmed, symptomatic arterial or venous thromboembolism [TE]Need of either:Continuous Positive Airway Pressure (Cpap) or Non-Invasive Ventilatio...
Source: Trials - Category: Research Source Type: clinical trials
In the aging society, the use of antithrombotic therapy (ATT) has been increasing in patients who are required for the prevention of thromboembolic diseases. Severe acute cholecystitis often requires the urgent drainage. Therefore, in these patients, ATT discontinuation to safely perform gallbladder drainage is often impossible since there is no time to discontinue ATT for the recommended period. In addition, the discontinuation ATT increases a risk of thromboembolism. An increased risk of bleeding complications during surgery and percutaneous drainage is also found in patients with acute cholecystitis receiving ATT.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Oral abstracts Source Type: research
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