GASTROENTEROLOGY ARTICLE OF THE WEEK
February 4, 2010
ASGE Guideline. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 2009;70:1060-1070.
1. Which of the following conditions are considered low risk for thromboembolism
a. Non-valvular atrial fibrillation
b. Mechanical valve in the aortic position
c. Acute coronary syndrome
d. Stent placed <1 yr ago
e. Dilation of coronary artery without stent after MI
2. Which of the following procedures are considered low risk procedures
a. Colonoscopy with biopsy
b. ERCP with sphincterotomy
c. EGD with esophageal dilation
d. Diagnostic balloon assisted enteroscopy
e. EGD with PEG
f. Treatment of varices
True or False
3. Efficacy of hemostatic endoscopic therapy in patients with INR between 1.5 to 2.5 is similar to the efficacy in non-anticoagulated patients
4. Platelet transfusion should be considered in patients on anti-platelet therapy with significant GI bleeding
5. Elective and semi-elective procedures in patients receiving dual anti-platelet therapy should be delayed until the minimum length of therapy is received, and one of the two agents should be withheld prior to the procedure
6. “Bridge therapy” with low molecular weight heparin has been proven safe in patients with mechanical valves and is considered standard of care
7. After endoscopic therapy of GI bleed in patients taking aspirin therapy, withholding aspirin therapy for 30 days resulted in an increase in thrombotic events
8. Dual antiplatelet therapy increases the risk of GI bleed 3-fold
9. Clips should be routinely placed after performing polypectomy in patients who are on anticoagulation
10. After an endoscopic procedure, warfarin should be started the evening after the endoscopic procedure, and IV heparin should be started 2 to 6 hours after the procedure
11. Patient with a prosthetic valve and active bleeding should be reversed with high dose (10mg) IV vitamin K
12. Based on available data, it is safer to continue aspirin and withhold clopidigrel prior to polypectomy rather than withholding aspirin and continuing clopidigrel