GASTROENTEROLOGY ARTICLE OF THE WEEK
September 5, 2002
ASGE. Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures. Gastrointestinal Endosc 2002;55:775-779.
1 Low risk procedures for anticoagulated patients include
a. EGD
b. EGD with biopsy
c. Colonoscopy
d. Colonoscopy with biopsy
e. Polypectomy
f. Flexible sigmoidoscopy with or without biopsy
g. ERCP with sphincterotomy
h. Push enteroscopy
i. PEG placement
j. esophageal dilation
2. The risk of an embolic event for patients with a low risk condition in whom anticoagulation is suspended for 4 to 7 days is estimated to be
a. 1 to 2 per 100
b. 1 to 2 per 1000
c. 0.1 to 0.2 percent
d. 1 to 2 per 10,000
3. Mechanical heart valves
a. carry a 60% risk of embolism if the patient is not anticoagulated
b. carry a 4 per 100 patient-years risk of major embolism
c. risk of embolism is highest if co-existent atrial fibrillation and/or mitral valve
prosthesis
d. antiplatelet therapy alone decreases risk of embolism from 4 to 2.2 per 100
patient-years.
4. Conditions considered to be “low-risk” for embolic events include
a. chronic or paroxymal atrial fibrillation with no valvular heart disease
b. mechanical valves in the mitral and aortic locations
b. DVT
c. only aortic mechanical valve
d. atrial fibrillation and valvular heart disease
e. porcine valves
f. aortic prosthetic valve with a prior history of emboli
True or False
5. Warfarin therapy should be re-started 24 hours after successful endoscopic management of a bleeding lesion.
6. Risk of embolism in non anti-coagulated atrial fibrillation patients is 5% to 7% annually.
7. A prior history of non-bleeding peptic ulcer disease increases the risk of GI bleeding during anticoagulation.
8. Early cessation of anticoagulation for a short time period in patients with DVT significantly increases the risk of pulmonary embolus.
9. Aspirin and/or NSAID’s should be stopped 7 to 10 days prior to polypectomy.
10. For patients on heparin, the infusion should be stopped 4 to 6 hours prior to the scheduled high-risk procedure and can be re-started 2 to 6 hours after the procedure.
11. Vitamin K is the ideal agent to reverse anticoagulation when the INR needs to be normalized prior to endoscopic procedures.
12. Patients with a prior history of gastrointestinal bleeding have a 30% 3-year risk of bleeding while anticoagulated compared to a risk of 5% for those with no prior history of GI bleeding.
13. Emergent endoscopic procedures in a patient with active gastrointestinal bleeding who is taking coumadin should be performed even if the INR is supratherapeutic.
14. The risk of major hemorrhage after sphincterotomy is 10% to 15% if anticoagulation is resumed within 3 days.