The Periprocedural Management of Anticoagulation and Platelet Aggregation Inhibitors in Endoscopic Interventions

Intestinal bleeding is one of the most frequently occurring complications after endoscopic procedures (1). The risk may be aggravated by treatment with anticoagulants or platelet aggregation inhibitors (1). Whenever a patient being treated with any such medication is scheduled for an endoscopic intervention, the benefit of reducing the bleeding risk by interrupting treatment—or by switching temporarily to treatment with heparins, known as bridging—has to be weighed against the increased danger of thromboembolic complications. Before every endoscopy, therefore, the bleeding risk associated with the procedure, the importance of the treatment with anticoagulants or platelet aggregation inhibitors, and the urgency of the intervention must be carefully considered. This review summarizes the available evidence on management of anticoagulants and platelet aggregation inhibitors before endoscopic interventions, placing emphasis on recent advances in knowledge.