Korean J Gastroenterol.  2024 Jun;83(6):217-232. 10.4166/kjg.2024.040.

IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy

• Kang SJ
• Tae CH
• Bang CS
• Shin CM
• Jeong YH
• Choi M
• Hwang JH
• Saito Y
• Chiu PWY
• Rerknimitr R
• Khor C
• Khien VV
• Choi KD
• Shim KN
• Song GA
• Lee OY
• the Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines

• KMID: 2557109
• DOI: http://doi.org/10.4166/kjg.2024.040

Abstract

Antithrombotic agents, including antiplatelet agent and anticoagulants are widely used in Korea due to increasing incidence of cardio-cerebrovascular disease and aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. Clinical practice guideline regarding this issue which was developed by the Korean Society of Gastrointestinal Endoscopy was published in 2020. However, since then, new evidence has emerged for the use of dual antiplatelet therapy and direct anticoagulant management, and revised guidelines were issued in the US and Europe. Accordingly, the previous guidelines were revised, cardiologists also participated in the development group, and the recommendations went through a consensus process among international experts. This guideline presents 14 recommendations made according to the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and was reviewed by multidisciplinary experts. This guideline provides useful information that can assist endoscopists in the management of patients on antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

Keyword

Guideline; Platelet aggregation inhibitors; Anticoagulants; Endoscopy

Figure

• 

  Fig. 1 Postendoscopic submucosal dissection bleeding in aspirin users comparing the interruption and continuation groups. M-H, Mantel–Haenszel; CI, confidence interval.

• 

  Fig. 2 Postendoscopic submucosal dissection bleeding comparing the dual antiplatelet therapy and single antiplatelet therapy groups. DAPT, dual antiplatelet therapy; APA, antiplatelet agent; M-H, Mantel–Haenszel; CI, confidence interval.

• 

  Fig. 3 Suggested protocol for perioperative direct oral anticoagulant (DOAC) management. (●) means that DOACs can be administered on the same day if procedures that damage the mucosa (biopsy, cold snare polypectomy, etc.) were not performed. ((●)) means that DOACs can be administered two days after high-risk procedures if there are no risk factors for postprocedural bleeding and no symptoms or signs of postoperative bleeding. AM, ante meridiem; CrCl, creatinine clearance; PM, post meridiem.

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