Peri-endoscopy anticoagulation
Principles
[edit | edit source]- Use guidelines for reference, but make each decision on a case-by-case basis
- Bleeding is common but rarely life-threatening
- Consider whether the procedure is urgent, or can be deferred until the patient no longer needs anticoagulation
Risk of procedure-related bleeding
[edit | edit source]- Anticoagulation has little impact on low-risk procedures:
- Diagnostic gastroscopy, colonoscopy or balloon enteroscopy, including biopsies
- ERCP without sphincterotomy
- EUS without FNA
- Cold snare removal of small polyps
- Capsule endoscopy
- High-risk procedures should be done off anticoagulation:
- Large polypectomy (>1cm)
- EMR or submucosal dissection
- ERCP with sphincterotomy
- EUS with biopsy or therapeutic procedure
- Dilatation by Savary dilator, or balloon dilation
- Coagulation or ablation of tumours or vascular lesions by APC or LASER
- Variceal sclerotherapy
Risk of thromboembolism
[edit | edit source]- See 'anticoagulation' under 'perioperative medicine'
Restarting anticoagulation
[edit | edit source]- There is little hard data to guide practice
- Sphincterotomy - aim to restart on day 3 post-op, otherwise 10-15% risk of bleeding