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Clinical Practice and Guidelines for Managing Antithrombotics before and after Endoscopy: A National Survey Study

Authors
Jeon, Seong WooHong, Su JinLee, Soo TeikKim, HyungkilChun, Hoon Jai
Issue Date
May-2020
Publisher
거트앤리버 발행위원회
Keywords
Endoscopy; Guideline adherence; Antithrombotic agent
Citation
Gut and Liver, v.14, no.3, pp.316 - 322
Indexed
SCIE
SCOPUS
KCI
Journal Title
Gut and Liver
Volume
14
Number
3
Start Page
316
End Page
322
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/846
DOI
10.5009/gnl19133
ISSN
1976-2283
Abstract
Background/Aims: The proper handling of antithrombotics is critical, and this study aimed to assess guideline adherence in the management of antithrombotics before and after endoscopy. Methods: A survey questionnaire was developed. The respondents' demographic information was included, and the questionnaire was divided into the first section for forceps biopsy, the second for polypectomy, and the third for endoscopic submucosal dissection (ESD) in which aspirin, clopidogrel, combination therapy (aspirin and clopidogrel), warfarin, and direct oral anticoagulants (apixaban) were prescribed to imaginary patients. Results: A total of 415 endoscopists completed this survey (response rate of 6.2%, 415/6,673). The percentage of respondents who chose to proceed with biopsy for patients taking aspirin, those taking clopidogrel, those under combination therapy, those taking warfarin, and those taking apixaban was 89.4%, 74.2%, 61.0%, 38.6%, and 50.4%, respectively. Most respondents answered that they would discontinue aspirin, clopidogrel, and a combination of both drugs for 5 days before polypectomy or ESD (69.4%/76.9%, 83.6%/83.9%, and 53.3%/65.8%, respectively). The answers indicated that warfarin should be discontinued with heparin bridge therapy in high thromboembolic risk patients (polypectomy 70.1%, ESD 73.5%). Regarding apixaban use in polypectomy and ESD, 63.9% and 58.1% of respondents, respectively, chose answers consistent with the guidelines. Conclusions: The gap between the guidelines and clinical practice in the management of antithrombotics before and after endoscopy is considerable and should be addressed via educational strategies.
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Chun, Hoon Jai
Anam Hospital (Department of Gastroenterology and Hepatology, Anam Hospital)
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