The periprocedural management of patients on a direct oral

Pol. Arch. Med. Wewn. · Aug 2024

Review

The periprocedural management of patients on a direct oral anticoagulant undergoing an elective gastrointestinal endoscopic procedure.

This narrative review summarizes the current body of literature regarding periprocedural management of direct oral anticoagulant (DOAC)-treated patients undergoing digestive endoscopy since the publication of the 2022 American College of Gastroenterology - Canadian Association of Gastroenterology guidelines. We provide a detailed analysis of the thromboembolic risk, endoscopic procedure-specific bleeding risks, contemporary intraprocedural techniques to reduce the bleeding risk, and a summary of periprocedural DOAC guidelines developed by major gastrointestinal societies, including recommendations on procedure risk stratification. Despite data heterogeneity, the overall trend of the current literature supports the contemporary practice of a minimal DOAC interruption without the need for heparin bridging.

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- Christopher Hansen-Barkun, Myriam Martel, and Alan N Barkun.
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
- Pol. Arch. Med. Wewn. 2024 Aug 8; 134 (7-8).
AbstractThis narrative review summarizes the current body of literature regarding periprocedural management of direct oral anticoagulant (DOAC)-treated patients undergoing digestive endoscopy since the publication of the 2022 American College of Gastroenterology - Canadian Association of Gastroenterology guidelines. We provide a detailed analysis of the thromboembolic risk, endoscopic procedure-specific bleeding risks, contemporary intraprocedural techniques to reduce the bleeding risk, and a summary of periprocedural DOAC guidelines developed by major gastrointestinal societies, including recommendations on procedure risk stratification. Despite data heterogeneity, the overall trend of the current literature supports the contemporary practice of a minimal DOAC interruption without the need for heparin bridging.

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The periprocedural management of patients on a direct oral anticoagulant undergoing an elective gastrointestinal endoscopic procedure.

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