Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature

Table 2 Stratification of thrombotic risk according to international guidelines

Thrombotic risk category	Practice guidelines
	ASGE[3]	ESGE/BSG[4]	APAGE/APSDE[5]
Low-risk	Anticoagulant therapy: (1) Bileaflet aortic valve prosthesis without AF and no other risk factors for CVA; (2) VTE > 12 mo previous and no other risk factors; and (3) Atrial fibrillation with CHA2DS2-VASc score < 2	Antithrombotic therapy: (1) Ischaemic heart disease without coronary stent; (2) Cerbrovascular disease; and (3) Peripheral vascular disease.	Antithrombotic therapy: (1) Acute coronary syndrome or percutaneous coronary intervention > 6 mo ago; and (2) Stable coronary artery disease.
		Anticoagulant therapy: (1) Prosthetic metal heart valve in aortic position; (2) Xenograft heart valve; (3) Atrial fibrillation without valvular disease; (4) > 3 mo after venous thromboembolism; and (5) Thrombophilia syndromes
			Anticoagulant therapy: (1) Non-valvular atrial fibrillation with a CHA2DS2-VASc score ≤ 5; (2) Prosthetic valve without atrial fibrillation; and (3) > 3 mo after venous thromboembolism
Moderate-risk	Anticoagulant therapy: (1) Bileaflet aortic valve prosthesis and one or more of the following risk factors: AF, prior CVA or TIA, hypertension, diabetes, congestive heart failure, age > 75 yr; (2) VTE within the past 3-12 monon-severe thrombophilia (heterozygous factor V Leiden or prothrombin gene mutation); and (3) Recurrent VTEactive cancer (treated within 6 mo or palliative)
High-risk	Anticoagulant therapy: (1) Any mitral valve prosthesis; (2) Any caged-ball or tilting disc aortic valve prosthesis; (3) Recent (within 6 mo) CVA or TIA; and (4) Atrial fibrillation with CHA2DS2-VASc score ≥ 2	Antithrombotic therapy: (1) Drug eluting coronary artery stents within 12 mo of placement; and (2) Bare metal coronary artery stents within 1 mo of placement.	Antithrombotic therapy: (1) Acute coronary syndrome or percutaneous coronary intervention 6 wk–6 mo.
			Anticoagulant therapy: (1) Non-valvular atrial fibrillation with a CHA2DS2-VASc score > 5; (2) Metallic mitral valve; (3) Prosthetic valve with atrial fibrillation; (4) < 3 mo after venous thromboembolism; and (5) Severe thrombophilia (protein C or protein S deficiency and (6) antiphospholipid syndrome)
		Anticoagulant therapy: (1) Prosthetic metal heart valve in mitral position; (2) Prosthetic heart valve and atrial fibrillation; (3) Atrial fibrillation and mitral stenosis; and (4) < 3 mo after venous thromboembolism
Very high-risk			Antithrombotic therapy: Acute coronary syndrome or percutaneous coronary intervention < 6 wk

ASGE: American society for gastrointestinal endoscopy; ESGE/BSG: European society of gastrointestinal endoscopy and British society of gastroenterology; APAGE/APSDE: Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy; AF: Atrial fibrillation; CVA: Cerebrovascular accident; VTE: Venous thromboembolism; TIA: Transient ischemic attack.