GASTROENTEROLOGY ARTICLE OF THE WEEK
October 5, 2006
Makar GA, Ginsberg G. Therapy insight: Approaching endoscopy in anticoagulated patients. Nature Gastroenterol Hepatol 2006;3:43-52,
1. Endoscopic procedures classified as “high-risk” for bleeding include
a. Colonoscopy with biopsy
b. PEG placement
c. Variceal Banding
d. ERCP without sphincterotomy
e. Polypectomy
f. Thermal ablation and coagulation
g. Esophageal dilation
h. EUS-guided FNA
True or False
2. Patients with mechanical prosthetic heart valves have a risk of thromboembolism of 4 per 100 patients when not on anticoagulation
3. Most patients with overt GI bleeding while anticoagulated t have an identifiable source on endoscopic evaluation
4. For endoscopic hemostasis to be successful, INR must be normalized to <1.5 in the actively bleeding anticoagulated patient.
5. For patients with low risk thromboembolic conditions who discontinue warfarin for 3-5 days prior to colonoscopy, warfarin should be re-started 3 days after completion of polypectomy.
6. The overall risk of thromboembolism in a patient with a low-risk embolic condition in whome anticoagulation is interrupted for 4-7 days is 1-2 per 1000 patients.
7. Stopping coumadin is followed by a state of rebound hypercoagulability that is clinically significant and increases risk of thrombosis.
8. Intravenous heparin should be discontinued 4-6 hours before the procedure and re-started 2-6 hours after the procedure.
9. The last injection of LMWH should be at least 8 hours before the procedure and administration should resume approximately 6 hours after the procedure
10. Properly done, bridging therapy and resumption of anticoagulation after a procedure is not associated with increased risk of bleeding