Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2020; 12(11): 408-450
Published online Nov 16, 2020. doi: 10.4253/wjge.v12.i11.408
Anticoagulation and antiplatelet management in gastrointestinal endoscopy: A review of current evidence
Andrew Chan, Hamish Philpott, Amanda H Lim, Minnie Au, Derrick Tee, Damian Harding, Mohamed Asif Chinnaratha, Biju George, Rajvinder Singh
Andrew Chan, Hamish Philpott, Amanda H Lim, Minnie Au, Derrick Tee, Damian Harding, Mohamed Asif Chinnaratha, Biju George, Rajvinder Singh, Department of Gastroenterology, Lyell McEwin Hospital, Adelaide 5112, South Australia, Australia
Hamish Philpott, Derrick Tee, Damian Harding, Mohamed Asif Chinnaratha, Biju George, Rajvinder Singh, School of Medicine, The University of Adelaide, Adelaide 5005, Australia
Author contributions: Singh R did conception and design of manuscript, critical review, overall supervision of the study, and approved final manuscript; Chan A did design of manuscript, acquisition of data, statistical analysis and interpretation of data, writing of manuscript and critical review; Philpott H contributed to design and writing of manuscript, and critical review; Lim AH contributed to acquisition of data, and writing of manuscript; Au M contributed to acquisition of data; Tee D contributed to design of manuscript and critical review; Harding D, Chinnaratha MA, and George B contributed to critical review.
Conflict-of-interest statement: There are no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rajvinder Singh, FRACP, FRCP (C), MBBS, MPhil, MRCP, Professor, Department of Gastroenterology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, Adelaide 5112, South Australia, Australia. rajvinder.singh@sa.gov.au
Received: August 12, 2020
Peer-review started: August 12, 2020
First decision: September 16, 2020
Revised: October 1, 2020
Accepted: November 5, 2020
Article in press: November 5, 2020
Published online: November 16, 2020
Processing time: 96 Days and 2.3 Hours
Core Tip

Core Tip: The current position statements and guidelines from the major gastroenterology societies have provided endoscopists with an evidenced-based systematic approach to pre, peri and post-operative management of patients on anticoagulant and/or antiplatelet therapy, in the context of both low and high-risk endoscopic procedures. While there is sufficient evidence on the index bleeding risk for common endoscopic procedures in the absence of anticoagulant and/or antiplatelet use, the evidence surrounding the bleeding risk on anticoagulant and/or antiplatelet therapy is variable among different publications and is still evolving. In this review, we have summarised the available evidence, provided an overview, and described our recommended practical approach to anticoagulant and/or antiplatelet management in common endoscopic procedures. Finally, we have compared our recommendations against the current guidelines from the major gastroenterology societies to assimilate a new working reference, and to highlight any knowledge gaps and directions for future research.