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

Overview

Journal Gut

Specialty Gastroenterology

Date 2016 Feb 14

PMID 26873868

Citations 78

Authors

Andrew M Veitch

Geoffroy Vanbiervliet

Anthony H Gershlick

Christian Boustiere

Trevor P Baglin

Lesley-Ann Smith

Franco Radaelli

Evelyn Knight

Ian M Gralnek

Cesare Hassan

Jean-Marc Dumonceau

Affiliations

Soon will be listed here.

Abstract

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 (or estimated glomerular filtration rate, eGFR) of 30-50 mL/min we recommend that the last dose of DOAC be taken 72 h before the procedure (very low quality evidence, strong recommendation). In any patient with rapidly deteriorating renal function a haematologist should be consulted (low quality evidence, strong recommendation).

Citing Articles

Factors associated with delayed bleeding following ampullectomy: A retrospective cohort study.

Pawlak K, Khalaf K, Gupta S, Tham D, Chon J, Mokhtar A DEN Open. 2025; 5(1):e70078.

PMID: 39959850 PMC: 11827579. DOI: 10.1002/deo2.70078.

Perioperative Factor Xa Inhibitor Discontinuation for Patients Undergoing Procedures With Minimal or Low Bleeding Risk.

Lee S, Lee K, Park J, Lee Y, Oh Y, Han S JAMA Netw Open. 2025; 8(2):e2458742.

PMID: 39918817 PMC: 11806392. DOI: 10.1001/jamanetworkopen.2024.58742.

Post-endoscopic sphincterotomy delayed bleeding occurs in patients with just 1-day interruption of direct oral anticoagulants or hemodialysis.

Hasegawa S, Kurita Y, Yamazaki Y, Nihei S, Iizuka T, Misawa N DEN Open. 2025; 5(1):e70060.

PMID: 39822950 PMC: 11736286. DOI: 10.1002/deo2.70060.

Assessing ChatGPT4 with and without retrieval-augmented generation in anticoagulation management for gastrointestinal procedures.

Malik S, Kharel H, Dahiya D, Ali H, Blaney H, Singh A Ann Gastroenterol. 2024; 37(5):514-526.

PMID: 39238788 PMC: 11372545. DOI: 10.20524/aog.2024.0907.

Perioperative Management in Patients with Atrial Fibrillation Treated with Non-Vitamin K Antagonist Oral Anticoagulants Undergoing Minor Bleeding Risk Procedure: Rationale and Protocol for the PERIXa Study.

Kwon S, Lee S, Choi E, Lee K, Choi J, Ahn H Vasc Health Risk Manag. 2024; 20:231-244.

PMID: 38774425 PMC: 11107937. DOI: 10.2147/VHRM.S455530.

References

Cannegieter S, Rosendaal F, Briet E . Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation. 1994; 89(2):635-41. DOI: 10.1161/01.cir.89.2.635. View

Khot U, Wenk Lang A, Murali K, Parker M . Systematic review of the efficacy and safety of colorectal stents. Br J Surg. 2002; 89(9):1096-102. DOI: 10.1046/j.1365-2168.2002.02148.x. View

Qumseya B, Wolfsen C, Wang Y, Othman M, Raimondo M, Bouras E . Factors associated with increased bleeding post-endoscopic mucosal resection. J Dig Dis. 2012; 14(3):140-6. DOI: 10.1111/1751-2980.12002. View

Williams V, Watson T, Zhovtis S, Gellersen O, Raymond D, Jones C . Endoscopic and symptomatic assessment of anastomotic strictures following esophagectomy and cervical esophagogastrostomy. Surg Endosc. 2007; 22(6):1470-6. DOI: 10.1007/s00464-007-9653-6. View

Magnani G, Bonaca M, Braunwald E, Dalby A, Fox K, Murphy S . Efficacy and safety of vorapaxar as approved for clinical use in the United States. J Am Heart Assoc. 2015; 4(3):e001505. PMC: 4392433. DOI: 10.1161/JAHA.114.001505. View

Kereiakes D, Yeh R, Massaro J, Driscoll-Shempp P, Cutlip D, Steg P . Antiplatelet therapy duration following bare metal or drug-eluting coronary stents: the dual antiplatelet therapy randomized clinical trial. JAMA. 2015; 313(11):1113-21. PMC: 4481320. DOI: 10.1001/jama.2015.1671. View

Poincloux L, Rouquette O, Privat J, Gorce D, Abergel A, Dapoigny M . Large-balloon dilation of the sphincter of Oddi after sphincterotomy or infundibulotomy to extract large calculi or multiple common bile duct stones without using mechanical lithotripsy. Scand J Gastroenterol. 2012; 48(2):246-51. DOI: 10.3109/00365521.2011.647064. View

Rogers B, Silvis S, Nebel O, Sugawa C, MANDELSTAM P . Complications of flexible fiberoptic colonoscopy and polypectomy. Gastrointest Endosc. 1975; 22(2):73-7. DOI: 10.1016/s0016-5107(75)73705-7. View

Gershlick A, Richardson G . Drug eluting stents. BMJ. 2006; 333(7581):1233-4. PMC: 1702452. DOI: 10.1136/bmj.39058.554884.BE. View

10.

Conio M, Repici A, Battaglia G, De Pretis G, Ghezzo L, Bittinger M . A randomized prospective comparison of self-expandable plastic stents and partially covered self-expandable metal stents in the palliation of malignant esophageal dysphagia. Am J Gastroenterol. 2007; 102(12):2667-77. DOI: 10.1111/j.1572-0241.2007.01565.x. View

11.

Ubogu E, Zaidat O . Rectus sheath hematoma complicating percutaneous endoscopic gastrostomy. Surg Laparosc Endosc Percutan Tech. 2002; 12(6):430-2. DOI: 10.1097/00129689-200212000-00008. View

12.

Nomura E, Takagi S, Kikuchi T, Negoro K, Takahashi S, Kinouchi Y . Efficacy and safety of endoscopic balloon dilation for Crohn's strictures. Dis Colon Rectum. 2006; 49(10 Suppl):S59-67. DOI: 10.1007/s10350-006-0685-0. View

13.

Whitson M, Dikman A, von Althann C, Sanyal S, Desai J, Bamji N . Is gastroduodenal biopsy safe in patients receiving aspirin and clopidogrel?: a prospective, randomized study involving 630 biopsies. J Clin Gastroenterol. 2010; 45(3):228-33. DOI: 10.1097/MCG.0b013e3181eb5efd. View

14.

Guyatt G, Oxman A, Vist G, Kunz R, Falck-Ytter Y, Alonso-Coello P . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336(7650):924-6. PMC: 2335261. DOI: 10.1136/bmj.39489.470347.AD. View

15.

Nelson D, Freeman M . Major hemorrhage from endoscopic sphincterotomy: risk factor analysis. J Clin Gastroenterol. 1994; 19(4):283-7. DOI: 10.1097/00004836-199412000-00004. View

16.

Lee M, Kim J, Lee S, Lee B, Lee S, Lee Y . Effect of sustained use of platelet aggregation inhibitors on post-endoscopic sphincterotomy bleeding. Dig Endosc. 2014; 26(6):737-44. DOI: 10.1111/den.12271. View

17.

Namasivayam V, Prasad G, Lutzke L, Dunagan K, Borkenhagen L, Okoro N . The risk of endoscopic mucosal resection in the setting of clopidogrel use. ISRN Gastroenterol. 2014; 2014:494157. PMC: 4040204. DOI: 10.1155/2014/494157. View

18.

Hussain N, Alsulaiman R, Burtin P, Toubouti Y, Rahme E, Boivin J . The safety of endoscopic sphincterotomy in patients receiving antiplatelet agents: a case-control study. Aliment Pharmacol Ther. 2007; 25(5):579-84. DOI: 10.1111/j.1365-2036.2006.03225.x. View

19.

Hart R, Pearce L, Aguilar M . Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007; 146(12):857-67. DOI: 10.7326/0003-4819-146-12-200706190-00007. View

20.

Toyonaga T, Man-I M, East J, Nishino E, Ono W, Hirooka T . 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc. 2012; 27(3):1000-8. PMC: 3572381. DOI: 10.1007/s00464-012-2555-2. View