Management of antithrombotics in GI bleed, endoscopy addressed

In a clinical practice guideline issued jointly by the American College of Gastroenterology and the Canadian Association of Gastroenterology and published online March 17 in the American Journal of Gastroenterology, updated recommendations are presented for the periendoscopic management of anticoagulants and antiplatelets during acute gastrointestinal (GI) bleeding and in the elective endoscopy setting.

Neena S. Abraham, M.D., from the Mayo Clinic in Scottsdale, Arizona, and colleagues conducted a systematic review to develop recommendations for periendoscopic management of anticoagulant and antiplatelet drugs during acute GI bleeding and the elective endoscopic setting.

For patients presenting with acute GI bleeding, the authors suggest against giving fresh frozen plasma or vitamin D for patients on warfarin; prothrombin complex concentrate (PCC) is suggested if needed, rather than fresh frozen plasma administration. The authors suggest against PCC administration for patients on direct oral anticoagulants. For patients on antiplatelet agents, the authors suggest against platelet transfusions. For patients in the elective endoscopy setting, continuation of warfarin is suggested as opposed to temporary interruption; however, for procedures with a high risk for GI bleeding in whom it is held, the guideline suggests against bridging anticoagulation, unless the patient has a mechanical heart valve.

"We suggest future studies focus on areas where insufficient evidence currently exists to inform clinical decisions," the authors write.