PTU-025 Endoscopy in Patients Having Long-term Oral Anticoagulant Therapy. Challenge or Routine Daily Practice?

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Abstract

Introduction

While oral anticoagulant therapy increases the possibility of bleeding, withholding it could cause thromboembolic complications. The BSG provides guidance regarding endoscopy and anticoagulation. Patients may be considered as having a high thromboembolic risk depending on the indication for anti-coagulation. The endoscopic procedures can be classified as high or low risk for bleeding.

Aim

To assess the number of significant bleeding events and thromboembolic events in patients undergoing gastrointestinal endoscopy and are being administered anticoagulants.

Methods

Patients who had an endoscopy at Mater Dei Hospital from January 2011 to December 2012 and were on oral anticoagulants were identified through the endoscopy database. Their endoscopy report and their clinical case notes were reviewed.

Results

130 patients were recruited. 55% were female. The mean age was 68.6 years (SD +/- 11 years; range 14–89 years). The main indication for anticoagulation with warfarin was atrial fibrillation (56.3%). 44.1% of all procedures involved conditions of high thromboembolic risks. Table 1 demonstrates the indication for anticoagulation and the procedure risk stratification.

Results

53.8% of all patients had a colonoscopy. 22.9% of procedures were classified as high risk for bleeding.1 patient (1.4%) had haemorrhoid banding. The other has polypectomy (>1cm).

Results

43.1% of patients had an OGD. 10.7% had high risk procedures for bleeding – 1 patient (1.8%) had a gastric polypectomy and 8.9% had variceal banding.

Results

3.1% (4 patients) of patients had a flexible sigmoidoscopy. 2 patients had a polypectomy (>1cm) and the other 2 had haemorrhoid banding (all classified as high risk for bleeding).

Results

1 patient developed a pre-retinal haemorrhage and a vitreal haemorrhage within 30 days post-procedure. This patient had a transcatheter aortic valve implantation and AF (high risk for thromboembolic events). This patient had an OGD where a small angioectatic vessel was coagulated with APC. The INR before and after the procedure was always within therapeutic range. There were no other thromboembolic or significant bleeding events recorded in these patients.

Conclusion

Our results demonstrate that adherence to the BSG guidelines on anticoagulation is highly important as to prevent any significant bleeding or thromboembolic complications. However, a new challenge for endoscopists will be the introduction and the wider availability of the new oral anticoagulants.

Disclosure of Interest

None Declared.

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