Management of Antithrombotic Therapy for Gastroenterological Endoscopy from a Cardio-Cerebrovascular Physician's Point of View

Periprocedural management of antithrombotics for gastroenterological endoscopy is a common clinical issue. To decide how to manage the use of antithrombotics in patients undergoing endoscopy, the risk for hemorrhage and thromboembolism during the procedure must be considered. For low-risk procedures, no adjustments in antithrombotics are needed. For high-risk procedures with a low thromboembolic risk, discontinuation of warfarin at 5 days, and clopidogrel at 5 to 7 days before the procedure has been recommended. However, it is better to continue aspirin use even during high-risk procedures. A heparin bridging therapy may be considered before endoscopy in patients with a high thromboembolic risk. The management of patients taking antithrombotics remains complex, especially in high-risk settings.