| Theme |
Topics of Gastrointestinal Hemorrhage |
| Title |
Management of Anticoagulant and Antiplatelet Agents for Endoscopic Procedures |
| Author |
Hiroshi Arakawa |
Department of Endoscopy, The Jikei University School of Medicine |
| Author |
Mitsuru Kaise |
Department of Endoscopy, The Jikei University School of Medicine |
| Author |
Shoichi Saito |
Department of Endoscopy, The Jikei University School of Medicine |
| Author |
Hiroo Imazu |
Department of Endoscopy, The Jikei University School of Medicine |
| Author |
Tomohiro Kato |
Department of Endoscopy, The Jikei University School of Medicine |
| Author |
Hisao Tajiri |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine |
| [ Summary ] |
In 2005, a new guideline for the managenment of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures was published by the Japan Gastroenterological Endoscopy Society (JGES). The new JGES guideline weighed the increased risk of thromboembolism caused by withdrawing anticoagulant and antiplatelet agents, and recommnded shortening cessation periods for these agents before endoscopic procedures and substituting heparin for these agents during cessation periods in cases with highly thromboembolic conditions. We established a new guideline for our university hospital in reference to the new JGES guideline in 2008. In our guideline, diagnostic endoscopy and other low risk procedures are recommended so that we may continue these agents without biopsies in cases with highly thromboembolic conditions. If there are any lesions requiring biopsy then another endoscopic examination for biopsies will be done later after stopping administration of these agents or heparin. Therapic procedures and EUS-FNA (high risk procedures) are undertaken when these agents have been stopped for seven to ten days before the procedure, the same as for perioperative management. More clinical evidence is needed to evaluate the adequacy of the new JGES guideline as well as our hospital guidelines. |