| Theme | Management of antithrombotic agents for colorectal endoscopic procedures -- Validity of new guideline by Japan Gastroenterological Endoscopy Society | |
|---|---|---|
| Title | Management of patients taking antithrombotic agents before gastroenterological endoscopy | |
| Publish Date | 2014/09 | |
| Author | Takuya Inoue | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Yosuke Abe | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Munetaka Iguchi | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Naoki Yorifuji | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Kaori Fujiwara | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Taisuke Sakanaka | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Sadaharu Nouda | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Kazuki Kakimoto | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Toshihiko Okada | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Ken Kawakami | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Toshihisa Takeuchi | Second Department of Internal Medicine, Osaka Medical Collage |
| Author | Kazuhide Higuchi | Second Department of Internal Medicine, Osaka Medical Collage |
| [ Summary ] | Withdrawal of antithrombotic agents for gastroenterological endoscopy can be associated with life threatening thromboembolisms. Therefore, the Japan Gastroenterological Endoscopy Society is more focused on thromboembolism prevention than gastrointestinal hemorrhaging associated with continuation of antithrombotic agents, as revealed in their 2012 guidelines. According to these guidelines, warfarin should be replaced with unfractionated heparin 3 to 5 days before endoscopy. In our hospital, patients are usually admitted 5 to 7 days before endoscopic mucosal resection (EMR) of colonic polyps, and warfarin is replaced with a continuous infusion of 10,000 to 15,000 units of heparin per day until 3 to 6 hours before EMR procedures. In the case of novel oral anticoagulants being used, patients are admitted 1 to 2 days before EMR, and heparin replacement is performed. However, so far, the level of evidence is not adequate to prove the efficacy of this treatment modality. | |