Antiplatelet and anticoagulant drugs management before gastrointestinal endoscopy: Do clinicians adhere to current guidelines?. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Bruno, Mauro; Marengo, Andrea; Elia, Chiara; Caronna, Stefania; Debernardi-Venon, Wilma; Manfrè, Selene Francesca; Musso, Alessandro; Puglisi, Flavia; Sguazzini, Carlo; Rizzetto, Mario; De Angelis, Claudio
• Is Part Of: Digestive and liver disease. Volume 47:Issue 1(2015)
• Page Start: 45
• Page End: 49
• Publication Date: 2015-01
• Subjects: Antithrombotic drugs -- Compliance -- Digestive endoscopy -- Guidelines; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2014.10.017
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: Managing antiplatelet and anticoagulant drugs before endoscopy may be challenging. Aims: To assess whether the pre-endoscopic management of antiplatelet/anticoagulant drugs is adherent to current guidelines and the influence of patients' characteristics, referring physician's specialty, type of endoscopic procedure and therapeutic regimen on adherence. Methods: Two hundred and twenty patients taking aspirin, thienopyridines or warfarin and scheduled for upper endoscopy (± biopsies), variceal band ligation, colonoscopy (± biopsies or polypectomy), were prospectively analyzed. Results: In 109 patients (49.5%) the management of antiplatelet/anticoagulant drugs was thoroughly compliant with guidelines. Neither demographic characteristics, nor in/outpatient status, nor type of endoscopic procedure, nor physician's specialty influenced the adherence but the therapeutic regimen had a significant impact ( p < 0.0001) as compliance was less likely in patients on warfarin. Unwarranted drugs withholding was more frequent before colonoscopy than upper endoscopy ( p = 0.0001). Warfarin was stopped longer than recommended more frequently than aspirin ( p = 0.009). The International Normalized Ratio was properly checked before endoscopy in 47.7% of patients. Among the 55 patients who withheld warfarin, the decision about bridging to low molecular weight heparin was appropriate in 21 (38.2%). Conclusions: Compliance with guidelines is low especially in the management of warfarin, both among gastroenterologists and other physicians.