Management of Anticoagulants and Antiplatelet Agents in Elective Endoscopy: Weighing the Risks and Benefits

A s the indications for endoscopic diagnosis and therapy continue to expand, an increasing number of patients receiving anticoagulants and antiplatelet agents will be encountered in gastroenterology practice.The management of these patients at the time of elective endoscopy can be challenging.Furthermore, this population has not been well studied, and thus, current guidelines are largely based on expert opinion.Ultimately, the risk of bleeding must be weighed against the risk of thromboembolic events when deciding whether to reverse anticoagulation or discontinue antiplatelet therapy before endoscopy.The present paper discusses three scenarios to highlight the authors' own clinical practice, and reviews the current published guidelines on this topic. CASES TO CONSIDERCase 1 A 58-year-old man is scheduled for a screening colonoscopy.He is asymptomatic, but his brother had colonic polyps and his father was diagnosed with colon cancer at 60 years of age.The patient has essential hypertension and is on lifelong warfarin therapy for chronic atrial fibrillation.He has no history of thromboembolic events.