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Dig Liver Dis ; 47(1): 45-9, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25464898

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.


Subject(s)
Anticoagulants/therapeutic use , Endoscopy, Gastrointestinal/methods , Guideline Adherence/statistics & numerical data , Platelet Aggregation Inhibitors/therapeutic use , Practice Guidelines as Topic , Preoperative Care/methods , Aged , Aged, 80 and over , Aspirin/therapeutic use , Biopsy , Cohort Studies , Colonic Polyps/surgery , Colonoscopy/methods , Colonoscopy/standards , Endoscopy, Digestive System/methods , Endoscopy, Digestive System/standards , Endoscopy, Gastrointestinal/standards , Esophageal and Gastric Varices/surgery , Female , Gastroenterology/statistics & numerical data , Humans , Ligation , Male , Middle Aged , Practice Patterns, Physicians'/statistics & numerical data , Preoperative Care/standards , Prospective Studies , Thienopyridines/therapeutic use , Warfarin/therapeutic use
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