Management of anticoagulation for gastrointestinal endoscopic procedures

Endoscopic procedures, particularly those requiring mucosal biopsy or polypectomy, are associated with an increased risk of gastrointestinal bleeding during or after procedure. This risk is increased in patients treated with chronic anticoagulant therapy.Anticoagulant therapy needs to be withheld for certain high-risk endoscopic procedures to prevent bleeding complications. However, this may expose some patients to an increased risk of thromboembolic complications during this period, particularly in patients with recent episodes of venous or arterial thromboembolism and those with prosthetic mechanical valves.Identifying patients at a high risk for thromboembolic complications and more aggressively managing their anticoagulant regimen (by switching to heparin) in preparation for the endoscopic procedure decreases the length of time they remain unanticoagulated and helps minimize complications.Low molecular weight heparin as a bridging therapy in preparation for endoscopic procedures can obviate unnecessary hospitalization and is an attractive strategy for managing high-risk patients.