CAREFUL ENDOSCOPIC PROCEDURES ARE REQUIRED IN THE CASE OF PATIENTS ON ANTICOAGULATION AND ANTIPLATELET THERAPY

DOI 16 References

Bibliographic Information

Other Title
  • 抗血栓薬継続下での内視鏡処置の注意点

Search this article

Abstract

Endoscopic procedures in patients on anticoagulation therapy or antiplatelet therapy pose an increased risk of hemorrhage. Discontinuation of anticoagulation or antiplatelet therapy, however, has the risk of life-threating complications in some patients. In such patients, anticoagulation therapy should be replaced with heparin therapy while the minimum antiplatelet therapy is continued. Although endoscopic biopsies and therapeutic approaches (i.e. ESD, EMR and EPBD) on aspirin therapy add increased risk of hemorrhage, these procedures are feasible when performed with care. Confirmation of complete hemostasis at the end of each procedure is the most crucial in avoiding undue post-procedural bleeding. For the endoscopic biopsies, it is important to use endoscopic forceps with a small cup and to collect as small a specimen as possible from the surface tissue of the lesion. If the hemostasis after biopsy is incomplete, add compression hemostasis with endoscopic forceps and/or spray hemostatic agents (e.g. thrombin, epinephrine and sodium alginate). In endoscopic therapeutic approaches, the ulcer floor should be thoroughly coagulated after ESD or EMR, and ulcers should be closed with endoclips wherever possible. For endoscopic cholangiolithotomy, EPBD is preferred, and a pancreatic stent should be placed before EPBD or EST to prevent post-ERCP pancreatitis.

Journal

References(16)*help

See more

Keywords

Details 詳細情報について

Report a problem

Back to top