Retrospective analysis on the management of anticoagulants and antiplatelet agents for scheduled endoscopy

The guideline on the management of anticoagulants and antiplatelet agents for endoscopic procedures was established by the Japan Gastroenterological Endoscopy Society in 2005. However, the degree to which this guideline has reached prescribing doctors in other fields has not, so far, been evaluated.

Medical records of all patients who underwent scheduled endoscopy from January 2008 to December 2008 in the Department of Gastroenterology at the University of Tokyo were investigated retrospectively.

Among 8921 patients underwent scheduled endoscopy, 1383 patients (15.5%) were receiving anticoagulants or antiplatelet agents. 324 patients (23.4%) were receiving warfarin as an anticoagulant. The most common antiplatelet agent was aspirin in 884 patients (63.9%), followed by ticlopidine in 150 patients (10.8%). Most patients taking warfarin alone (51.6%) or a combination of aspirin and ticlopidine (68.4%) underwent endoscopy without cessation. In contrast, most patients taking aspirin alone (46.0%) or ticlopidine alone (56.3%) underwent endoscopy after a cessation period of 6–7 days, indicating the low permeation of the cessation policy recommended in the guideline. Among 556 patients underwent endoscopy without a cessation period, 41 patients (7.4%) underwent invasive procedures including endoscopic mucosal resection. No bleeding complications were observed in patients who underwent invasive procedures without a cessation period.

We revealed the low permeation of the guideline to prescribing doctors. Cessation before endoscopy to avoid bleeding complications can be dispensable.