Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period
Official guideline from the American College of Gastroenterology.
Management (Acute GI Bleeding)
For patients with GI bleeding on cardiac ASA for secondary prevention, we suggest against holding the ASA.
For patients on warfarin who are hospitalized or under observation with acute GI bleeding, we suggest against FFP administration.
For patients on warfarin who are hospitalized or under observation with acute GIB, we suggest PCC administration compared with FFP administration.
For patients on warfarin who are hospitalized or under observation with acute GIB (upper and/or lower), we suggest against the use of vitamin K.
Management (Elective Endoscopy)
For patients on warfarin, who hold warfarin in the periprocedural period for elective/planned endoscopic GI procedures, we suggest against bridging anticoagulation.
For patients on warfarin undergoing elective/planned endoscopic GI procedures, we suggest warfarin be continued, as opposed to temporarily interrupted (1–7 days)
For patients on DOACs who are undergoing elective/planned endoscopic GI procedures, we suggest temporarily interrupting DOACs rather than continuing DOACs.
In patients who are undergoing elective endoscopic GI procedures whose warfarin was interrupted, we could not reach a recommendation for or against resuming warfarin the same day vs 1–7 days after the procedure.
For patients on dual antiplatelet therapy for secondary prevention who are undergoing elective endoscopic GI procedures, we suggest temporary interruption of the P2Y12 receptor inhibitor while continuing ASA.
For patients on ASA 81–325 mg/d (i.e., cardiac ASA monotherapy) for secondary prevention, we suggest against interruption of ASA.
How strong is the ACG's recommendation?