Tactics for managing patients receiving antithrombotic therapy during endoscopic examinations
https://doi.org/10.31146/2415-7813-endo-67-4-15-24
Abstract
There are international and Russian guidelines dedicated to the management of endoscopic interventions in patients taking anticoagulants: from the Federation of Anesthesiologists and Reanimatologists of Russia (FAR) dated 2025, the European Society of Gastrointestinal Endoscopy (ESGE) dated 2021, the American Society for Gastrointestinal Endoscopy (ASGE) dated 2016, and the Japan Gastroenterological Endoscopy Society (JGES) dated 2013 with an addendum from May 2018. These guidelines are based on various studies and have some discrepancies in certain aspects, related to regional differences. We conducted a comparative analysis of these clinical guidelines for planned endoscopic interventions based on the type of drug (acetylsalicylic acid, P2Y12 inhibitors, warfarin, direct oral anticoagulants), the bleeding risk of the planned endoscopic procedure (low/high), and the individual patient’s thrombotic risk (assessed using the CHA₂DS₂-VASc, Caprini, and other scales). This article is a valuable practical review that helps clinicians optimize patient management tactics.
About the Authors
P. A. Zholobova
Almazov National Medical Research Centre of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
V. F. Kamalova
Almazov National Medical Research Centre of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
E. G. Solonitsyn
Almazov National Medical Research Centre of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
References
1. Zabolotskikh I.B., Bautin A.E., Boev S.S., et al. Perioperative management of patients receiving anticoagulants and antiplatelet agents. Methodological recommendations of the Russian National Association “Federation of Anesthesiologists and Reanimatologists”. 2025 revision. Vestnik Intensivnoi Terapii Imeni A.I. Saltanova. 2025;(2):11-46. (in Russ.) doi: 10.21320/1818-474X-2025-2-11-46.@@ Заболотских И.Б., Баутин А.Е., Боев С.С. и соавт. Периоперационное ведение пациентов, получающих антикоагулянты и антиагреганты. Методические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов». Пересмотр 2025 года. Вестник интенсивной терапии им. А.И. Салтанова. 2025;(2):11-46. doi: 10.21320/1818-474X-2025-2-11-46.
2. Veitch A.M., Radaelli F., Alikhan R. et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Endoscopy. 2021;53(9):947-969. doi: 10.1055/a-1305-7556.
3. Acosta R.D., Abraham N.S., Chandrasekhara V. et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointestinal Endoscopy. 2016;83(1):3-16. doi: 10.1016/j.gie.2015.09.035.
4. Fujimoto K., Fujishiro M., Kato M. et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Digestive Endoscopy. 2014;26(1):1-14. doi: 10.1111/den.12183.
5. Kato M., Uedo N., Hokimoto S. et al. Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment: 2017 Appendix on Anticoagulants Including Direct Oral Anticoagulants. Digestive Endoscopy. 2018;30(4):433-440. doi: 10.1111/den.13184.
6. Panchenko E.P., Dobrovolsky A.V., Titaeva E.V. et al. Antithrombotic therapy in patients with stable manifestations of atherothrombosis. Cardiovascular Therapy and Practice. 2009;8(6):4-11. doi: 10.15829/1728-8800-2009-6-4-11.@@ Панченко Е.П., Добровольский А.В., Титаева Е.В. и соавт. Антитромботическая терапия у больных со стабильными проявлениями атеротромбоза. Кардиоваскулярная терапия и практика. 2009;8(6):4-11. (in Russ.) doi: 10.15829/1728-8800-2009-6-4-11.
7. Mahady S.E., Margolis K.L., Chan A. et al. Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut. 2021;70(4):717-724. doi: 10.1136/gutjnl-2020-321585.
8. Chan F.K.L., Goh K.L. Anticoagulation and antiplatelet management in gastrointestinal endoscopy: A review of current evidence. World Journal of Gastrointestinal Endoscopy. 2020;12(11):408-450. doi: 10.4253/wjge.v12.i11.408.
9. Hogwood J., Mulloy B., Gray E. Pharmacology of Heparin and Related Drugs: An Update. Pharmacological Reviews. 2023;75(2):328-379. doi: 10.1124/pharmrev.121.000502.
10. Staroverov I.I. Low molecular weight heparins. Atmosphere. Cardiology News. 2005;(1):19-21. doi: 10.15829/1728-8800-2005-1-19-21.@@ Староверов И.И. Низкомолекулярные гепарины. Атмосфера. Новости кардиологии. 2005;(1):19-21. doi: 10.15829/1728-8800-2005-1-19-21.
11. Averkov O.V., Gilyarov M.Y., Barbarash O.L. et al. Acute myocardial infarction with ST segment elevation: clinical guidelines.Russian Journal of Cardiology. 2020;25(11):143-238. (in Russ.) doi: 10.15829/1560-4071-2020-4103.@@ Аверков О.В., Гиляров М.Ю., Барбараш О.Л. и соавт. Острый инфаркт миокарда с подъёмом сегмента ST электрокардиограммы: клинические рекомендации. Российский кардиологический журнал. 2020;25(11):143-238. doi: 10.15829/1560-4071-2020-4103.
12. Douketis J.D., Spyropoulos A.C., Spencer F.A. et al. Perioperative Management of Antithrombotic Therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl): e326S-e350S. doi: 10.1378/chest.11-2298.
13. ESC/EACTS Guidelines for the management of patients with valvular heart disease.Russian Journal of Cardiology. 2022;27(7):5160. doi: 10.15829/1560-4071-2022-5160.@@ 2021 Рекомендации ESC/EACTS по ведению пациентов с клапанной болезнью сердца. Российский кардиологический журнал. 2022;27(7):5160. doi: 10.15829/1560-4071-2022-5160.
14. Zabolotskikh I.B., Bautin A.E., Boev S.S. et al. Perioperative management of patients receiving long-term antithrombotic therapy. Clinical practice recommendations of the national “Federation of Anesthesiologists and Reanimatologists”. Annals of Critical Care. 2021;(3):7-26. (in Russ.) doi: 10.21320/1818-474X-2021-3-7-26.@@ Заболотских И.Б., Баутин А.Е., Боев С.С. и соавт. Периоперационное ведение пациентов, получающих длительную антитромботическую терапию. Клинические рекомендации Федерации анестезиологов и реаниматологов. Анналы критической медицины. 2021;(3):7-26. doi: 10.21320/1818-474X-2021-3-7-26.
15. Spadaccini M., Fugazza A., Frazzoni L. et al. Endoscopic papillectomy for neoplastic ampullary lesions: A systematic review with pooled analysis. United European Gastroenterology Journal. 2020;8(1):44-51. doi: 10.1177/2050640619872587.
16. Sung J.J.Y., Lau J.Y.W., Ching J.Y.L. et al. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Annals of Internal Medicine. 2010;152(1):1-9. doi: 10.7326/0003-4819-152-1-201001050-00179.
17. Burger W., Chemnitius J.M., Kneissl G.D. et al. Low-dose aspirin for secondary cardiovascular prevention - cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation - review and meta-analysis. Journal of Internal Medicine. 2005;257(5):399-414. doi: 10.1111/j.1365-2796.2005.01477.x.
18. Biondi-Zoccai G.G.L., Lotrionte M., Agostoni P. et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. European Heart Journal. 2006;27(22):2667-2674. doi: 10.1093/eurheartj/ehl334.
19. Veitch A.M., Vanbiervliet G., Gershlick A.H. et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Endoscopy. 2016;48(4):385-402. doi: 10.1055/s-0042-102652.
20. Kuzmina I.M., Gratsiansky N.A., Gilyarov M.Y. Antiplatelet therapy in acute coronary syndrome. Journal named after N.V. Sklifosovsky “Emergency Medical Care”. 2021;10(4):769-777. (in Russ.) doi: 10.23934/2223-9022-2021-10-4-769-777.@@ Кузьмина И.М., Грацианский Н.А., Гиляров М.Ю. Антиагрегантная терапия при остром коронарном синдроме. Журнал им. Н.В. Склифосовского «Неотложная медицинская помощь». 2021;10(4):769-777. doi: 10.23934/2223-9022-2021-10-4-769-777.
21. Gibson C.M., Mehran R., Bode C. et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. New England Journal of Medicine. 2016;375(25):2423-2434. doi: 10.1056/NEJMoa1611594.
22. Mabe K., Kato M., Ominami M. et al. A prospective, multicenter survey on the validity of shorter periendoscopic cessation of antithrombotic agents in Japan. Journal of Gastroenterology. 2017;52(1):50-60. doi: 10.1007/s00535-016-1206-0.
23. Yoshio T., Nishizawa T., Hirasawa K. et al. Gastric ESD under Heparin Replacement at High-Risk Patients of Thromboembolism Is Technically Feasible but Has a High Risk of Delayed Bleeding: Osaka University ESD Study Group. Gastroenterology Research and Practice. 2013;2013:365830. doi: 10.1155/2013/365830.
24. Ogiyama H., Inoue T., Maekawa A. et al. Effect of anticoagulants on the risk of delayed bleeding after colorectal endoscopic submucosal dissection. Endoscopy International Open. 2020;8(11): E1654-E1663. doi: 10.1055/a-1244-2097.
Review
For citations:
Zholobova P.A., Kamalova V.F., Solonitsyn E.G. Tactics for managing patients receiving antithrombotic therapy during endoscopic examinations. Filin’s Clinical endoscopy. 2025;67(4):15-24. (In Russ.) https://doi.org/10.31146/2415-7813-endo-67-4-15-24
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