Management of Platelet-Directed Pharmacotherapy in Patients With Atherosclerotic Coronary Artery Disease Undergoing Elective Endoscopic Gastrointestinal Procedures

Q: What are the key findings of this study?

Periprocedural management of antithrombotics during elective endoscopy requires balancing the procedure-related bleeding risk against the thromboembolic risk of therapy interruption.

Q: What is the clinical evidence from this study?

Population: Patients on antithrombotics undergoing elective endoscopic procedures. Intervention: Periprocedural management of antithrombotics.

Q: What does this research mean for the field?

Periprocedural decisions regarding the temporary interruption of platelet-directed pharmacotherapy in patients with coronary artery disease undergoing elective endoscopic procedures require a structured assessment balancing ischemic cardiac risk against gastrointestinal bleeding risk. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Richard C. Becker; James M. Scheiman; Harold L. Dauerman; Frederick A. Spencer; Sunil V. Rao; Marc Steven Sabatine; David A. Johnson; Faye Chan; Neena S. Abraham; Eamonn M.M. Quigley

doi:10.1016/j.jacc.2009.09.012

November 27, 2009Journal of the American College of CardiologyOpen Access

Management of Platelet-Directed Pharmacotherapy in Patients With Atherosclerotic Coronary Artery Disease Undergoing Elective Endoscopic Gastrointestinal Procedures

View Full Paper

Ask AI

Bookmark

Share

Why the study?

The periprocedural management of platelet-directed pharmacotherapy in patients with atherosclerotic coronary artery disease undergoing elective endoscopic gastrointestinal procedures is a common clinical scenario requiring guidance.

How should platelet-directed pharmacotherapy and anticoagulants be managed periprocedurally to balance bleeding and thromboembolic risks in patients undergoing elective gastrointestinal endoscopy?

Key Points

To summarize evidence and provide general risk-assessment guidance for managing platelet-directed pharmacotherapy in patients with atherosclerotic coronary artery disease undergoing elective endoscopic gastrointestinal procedures.
Formulated clinical practice recommendations through an adaptation process using AGREE II to evaluate 4 existing clinical guidelines identified from systematic searches (including MEDLINE, KoreaMed, and KoMGI) up to May 2018, supplemented by targeted searches for post-2016 evidence.
Synthesized evidence using the GRADE approach for evidence quality assessment (categorized as high, moderate, low, or very low) and classified recommendations into strong or weak categories.
Classified gastrointestinal endoscopic procedures into low-risk (anticipated bleeding risk <1%), high-risk (bleeding risk ≥1%), and ultra-high-risk categories (such as endoscopic submucosal dissection and endoscopic mucosal resection for colorectal polyps ≥2 cm).
Elective endoscopic procedures require balancing procedure-related bleeding risk against patient-specific thromboembolic risk, such as stent thrombosis in individuals who have undergone percutaneous coronary intervention.
High-risk endoscopic interventions carried an anticipated bleeding rate of 1% or greater, whereas low-risk procedures had a rate below 1%, defining thresholds for whether antiplatelet interruption is required.
In patients with drug-eluting stents placed for unstable angina or non-ST-segment elevation myocardial infarction, existing guidance recommends deferring elective non-cardiac interventions until 12 months have elapsed.

Structured PICO

How should platelet-directed pharmacotherapy and anticoagulants be managed periprocedurally to balance bleeding and thromboembolic risks in patients undergoing elective gastrointestinal endoscopy?

P

Population

Adult patients on antithrombotic therapy scheduled for elective endoscopic procedures, for whom bleeding and thromboembolic risks must be balanced.

I

Intervention

Temporary interruption or modification of platelet-directed pharmacotherapy and anticoagulation periprocedurally.

C

Comparator

Continuation of antithrombotic therapy without interruption.

O

Outcome

Risk of procedural complications (bleeding) and thromboembolic events associated with the interruption of antithrombotic agents.safety

This clinical practice guideline provides a structured approach for Korean clinicians to balance periprocedural gastrointestinal bleeding against cardiovascular thromboembolic risks in patients on antithrombotic therapy.

Limitations

Lack of sufficient domestic evidence requiring reliance on foreign data
Guidelines are not an absolute standard and require individualized clinical judgment
Lack of sufficient domestic clinical evidence, necessitating reliance on foreign data that may differ in endoscopic techniques and bleeding/thromboembolic risks.
The guideline is not an absolute standard of care and clinical judgment is required for individual patients.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Provides clinicians a framework for balancing bleeding and thromboembolic risks in elective endoscopy; extends prior guidelines via GRADE-adapted, localized recommendations.

Abstract

The periprocedural management of patients with atherosclerotic coronary heart disease, including those who have heart disease and those who are undergoing percutaneous coronary intervention and stent placement who might require temporary interruption of platelet-directed pharmacotherapy for the purpose of an elective endoscopic gastrointestinal procedure, is a common clinical scenario in daily practice. Herein, we summarize the available information that can be employed for making management decisions and provide general guidance for risk assessment.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Becker et al. (2009) studied Patients on antithrombotics undergoing elective endoscopic procedures. Periprocedural management of antithrombotics was evaluated. Periprocedural management of antithrombotics during elective endoscopy requires balancing the procedure-related bleeding risk against the thromboembolic risk of therapy interruption.

synapsesocial.com/papers/6acf153de9cf455829e37418 https://doi.org/10.1016/j.jacc.2009.09.012

View Full Paper

Ask AI

Bookmark

Share

Management of Platelet-Directed Pharmacotherapy in Patients With Atherosclerotic Coronary Artery Disease Undergoing Elective Endoscopic Gastrointestinal Procedures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Management of Platelet-Directed Pharmacotherapy in Patients With Atherosclerotic Coronary Artery Disease Undergoing Elective Endoscopic Gastrointestinal Procedures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading