Management of Anticoagulants & Antiplatelet Agents Pre and Post Endoscopy. Thomas Savides, M.D. Professor of Clinical Medicine. University of California, San Diego. Disclosures. None. Learning Objectives. Accurately assess the risk of bleeding in patients on anticoagulants and antiplatelet agents before endoscopic procedures. Learn the cardiovascular risk of modifying antiplatelet therapy in. Does the INR have to be within the normal range before endoscopy is performed? A: I do not wait for the INR to normalize if the patient is actively bleeding and potentially needs endoscopic therapy. Gut Check on Gastroenterology, an NEJM Journal Watch blog focusing on issues in clinical gastroenterology, was active from 2008 to 2014. This archive contains all posts and discussions from Gut Check’s history. October 15th, 2010 Plavix (Clopidogrel) and endoscopy: the great dilemma! Plavix and other platelet inhibitors have saved countless lives by preventing cardiovascular events. But. As the number of diagnostic and therapeutic gastrointestinal endoscopies is increasing, and there is an increase in number of patients taking blood thinners, we are seeing more and more patients on blood thinners prior to endoscopic procedures. 5 days before endoscopy Continue aspirin if already prescribed Liaise with cardiologist Consider stopping clopidogrel, prasugrel or ticagrelor 5 days before endoscopy if: – 12 months after insertion of drug-eluting coronary stent – 1 month after insertion of bare metal coronary stent Continue aspirin Clopidogrel prasugrel ticagrelor Fig.1 Guidelines for the management of patients on. GUIDELINE The management of antithrombotic agents for patients undergoing GI endoscopy Prepared by: ASGE STANDARDS OF PRACTICE COMMITTEE Ruben D. Acosta, MD, Neena S. Abraham, MD, MSCE, FASGE (invited content expert, ad-hoc member), Upper Endoscopy and Colonoscopy. Some medications (prescription and over-the-counter) can reduce your body’s ability to form blood clots and taking these before GI endoscopy procedures may increase your risk of bleeding during and after these tests. The risk of endoscopy in patients on antithrombotics depends on the risks of procedural haemorrhage versus thrombosis due to discontinuation of therapy. (See Management of anticoagulants in patients undergoing endoscopic procedures and Endoscopic procedures in patients with disorders of hemostasis.) SOCIETY GUIDELINES The American Society for Gastrointestinal Endoscopy (ASGE) has issued official guidelines based upon the available evidence and consensus opinion [ 1 ]. Antiplatelet Agents andAntiplatelet Agents and Endoscopy Neena S. Abraham, MD, MSCE, FACG Michael EMichael E. DeBakey Veterans Affairs Medical CenterVeterans Affairs Medical Center Sections of Gastroenterology & Health Services Research Associate Professor of Medicine Baylor College of Medicine, Houston, TX, USA Learning Objectives 1. To clarifyyyg the CV risk of modifying antiplatelet therapy.