Korean J Gastrointest Endosc.  2010 Apr;40(4):221-228.

Prophylactic Antibiotics, Anticoagulants and Antiplatelets for GI Endoscopy

• Park SM

Abstract

This review provides general recommendations, based on the literature, on antibiotic prophylaxis, anticoagulants and antiplatelets for GI endoscopy. Antibiotic prophylaxis is recommended for patients at high risk of infection - ERCP with incomplete drainage, ERCP with sterile pancreatic fluid collection (which communicates with the pancreatic duct), pancreatic pseudocyst drainage, EUS-FNA of cystic lesions, percutaneous endoscopic feeding tube placement and cirrhosis with acute GI bleeding. Prophylactic antibiotics are no longer recommended for GI endoscopy to prevent infectious endocarditis. To decide how to manage anticoagulants and antiplatelets during endoscopic procedures, the risk of an adverse ischemic event or a thromboembolic complication and the risk of bleeding must be weighed. For a low-risk procedure, no adjustments in anticoagulation and antiplatelets need to be made. For a high risk procedure, it is recommended to discontinue warfarin 3 to 5 days before the procedure and clopidogrel 7 to 10 days before. Low molecular weight heparin may be used as a bridge before endoscopy in patients with a high risk of a thromboembolism. In the absence of a pre-existing bleeding disorder, endoscopic procedures may be done in patients taking aspirin or other NSAIDs. Further controlled clinical studies are needed to clarify aspects of these recommendations.

Keyword

Prophylactic antibiotics; Anticoagulants; Antiplatelets; GI endoscopy

MeSH Terms

Anti-Bacterial Agents
Anti-Inflammatory Agents, Non-Steroidal
Antibiotic Prophylaxis
Anticoagulants
Aspirin
Cholangiopancreatography, Endoscopic Retrograde
Drainage
Endocarditis
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endoscopy
Fibrosis
Hemorrhage
Heparin, Low-Molecular-Weight
Humans
Pancreatic Pseudocyst
Thromboembolism
Ticlopidine
Warfarin
Anti-Bacterial Agents
Anti-Inflammatory Agents, Non-Steroidal
Anticoagulants
Aspirin
Heparin, Low-Molecular-Weight
Ticlopidine
Warfarin