Management of Antithrombotics before Endoscopy and Biopsy

ABSTRACT

Antithrombotics are increasingly used for the management and prevention of cardiovascular diseases, and endoscopists often have to decide whether to continue or stop these medications before endoscopy. The development of novel antithrombotics, such as direct oral anticoagulants, has complicated their management before endoscopy. Although the discontinuation of anticoagulants may decrease the incidence of bleeding after endoscopic procedures, discontinuation may also lead to more serious cardiovascular complications. Although the majority of current practice guidelines recommend continuation of antithrombotics before elective endoscopy and biopsy, surveys have shown that many endoscopists do not adhere to these guidelines, probably due to legal aspirations from post endoscopic bleeding. Thus, we examined the current guidelines for the management of antithrombotics before endoscopy.