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Management of anticoagulants in patients undergoing endoscopic procedures

Patrick S Kamath, MD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Gastroenterologic procedures are commonly performed in patients taking anticoagulants. However, there are limited data assessing the bleeding risk of specific procedures in these settings.

This topic will review the periprocedural management of patients taking anticoagulants. The management of patients taking antiplatelet agents, as well as patients with von Willebrand disease, hemophilia, renal failure, liver failure, and thrombocytopenia, are discussed elsewhere. (See "Management of antiplatelet agents in patients undergoing endoscopic procedures" and "Endoscopic procedures in patients with disorders of hemostasis".)


The American Society for Gastrointestinal Endoscopy (ASGE) has issued official guidelines regarding the management of patients taking anticoagulants based upon the available evidence and consensus opinion [1]. The recommendations in this topic review are consistent with the ASGE guidelines. This topic is also addressed in reviews and guidelines from the American College of Gastroenterology, the American College of Chest Physicians, the American College of Cardiology, and the British Society of Gastroenterology/European Society of Gastrointestinal Endoscopy, which make similar (though not identical) recommendations [2-5]. The management of newer antithrombotic agents has also been the subject of review articles [6,7].


In general, diagnostic endoscopic procedures are lower risk for bleeding than are therapeutic procedures (table 1). The procedure-related bleeding risk of various endoscopic procedures is discussed in detail elsewhere; a procedure is generally characterized as high risk if the procedure-related bleeding risk is ≥1 percent. (See "Endoscopic procedures in patients with disorders of hemostasis", section on 'Procedure-related bleeding risk'.)


The probability of a thromboembolic complication following reversal or discontinuation of anticoagulation depends upon the preexisting condition for which the medication was prescribed (table 2 and table 3). This topic is discussed in detail elsewhere. (See "Perioperative management of patients receiving anticoagulants", section on 'Estimating thromboembolic risk'.)

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Literature review current through: Nov 2017. | This topic last updated: Mar 02, 2017.
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