Gut Liver.  2020 May;14(3):316-322. 10.5009/gnl19133.

Clinical Practice and Guidelines for Managing Antithrombotics before and after Endoscopy: A National Survey Study

Affiliations
  • 1Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu
  • 2Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon
  • 3Department of Internal Medicine, Chonbuk National University Hospital, Jeonju
  • 4Department of Internal Medicine, Inha University Hospital, Incheon
  • 5Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea, Research Group for Endoscopic Submucosal Dissection in Korean Society of Gastrointestinal Endoscopy

Abstract

Background/Aims
The proper handling of antithrombotics is critical, and this study aimed to assess guideline adherence in the management of antithrombotics before and after endoscopy.
Methods
A survey questionnaire was developed. The respondents’ demographic information was included, and the questionnaire was divided into the first section for forceps biopsy, the second for polypectomy, and the third for endoscopic submucosal dissection (ESD) in which aspirin, clopidogrel, combination therapy (aspirin and clopidogrel), warfarin, and direct oral anticoagulants (apixaban) were prescribed to imaginary patients.
Results
A total of 415 endoscopists completed this survey (response rate of 6.2%, 415/6,673). The percentage of respondents who chose to proceed with biopsy for patients taking aspirin, those taking clopidogrel, those under combination therapy, those taking warfarin, and those taking apixaban was 89.4%, 74.2%, 61.0%, 38.6%, and 50.4%, respectively. Most respondents answered that they would discontinue aspirin, clopidogrel, and a combination of both drugs for 5 days before polypectomy or ESD (69.4%/76.9%, 83.6%/83.9%, and 53.3%/65.8%, respectively). The answers indicated that warfarin should be discontinued with heparin bridge therapy in high thromboembolic risk patients (polypectomy 70.1%, ESD 73.5%). Regarding apixaban use in polypectomy and ESD, 63.9% and 58.1% of respondents, respectively, chose answers consistent with the guidelines.
Conclusions
The gap between the guidelines and clinical practice in the management of antithrombotics before and after endoscopy is considerable and should be addressed via educational strategies.

Keyword

Endoscopy; Guideline adherence; Antithrombotic agent
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