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    BSG/ESGE Anticoagulation Guidelines on Endoscopy in Patients on Antiplatelet or Anticoagulation Therapy 2016

    1. Assess bleeding risk

    Source: BSG/ESGE

    2. Assess thrombotic risk

    Source: BSG/ESGE

    3. Bleeding vs thrombotic risk

    Source: BSG/ESGE

    Aspirin can be continued for all endoscopic procedures except endoscopic submucosal dissection (ESD), large colonic endoscopic mucosal resection (EMR) (>2 cm), upper gastrointestinal EMR and ampullectomy, which should be considered case by case.

    In summary,

    Low risk procedures

    • Antiplatelets: continue single or dual therapy.

    • Warfarin: continue but INR must be checked to ensure it is not exceeding therapeutic range in the week before the procedure.

    • Direct oral anticoagulants (DOACs): omit on day of procedure.

    High risk procedures

    Low thrombotic risk

    • Antiplatelets: discontinue 5 days before procedure. If dual therapy, continue aspirin.

    • Warfarin: discontinue 5 days before procedure and check INR <1.5 before procedure.

    • DOAC: discontinue at least 48h before procedure (for dabigatran with eGFR 3-50, at least 72h). If rapidly deteriorating renal function, liaise with haematologist.

    High thrombotic risk

    • Antiplatelets: continue aspirin, liaise with cardiologist about other antiplatelets.

    • Warfarin: bridge with LMWH. Advise increased risk of bleeding.

    • DOAC: as above DOACs

    4. Post-procedure

    Resume therapy up to 48h after procedure.


    Veitch AM, Vanbiervliet G, Gershlick AH, 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. Gut 2016;65:374-389.

Author: Ms Yanyu Tan  | Speciality: General Surgery  | Date Added: 12/11/2019


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