Management for endoscopic procedures in patients taking antithrombotic agents

Purpose: As the population ages, the prevalence of cardio-cerebrovascular diseases continues to rise, resulting in the increasingly widespread use of antithrombotic agents, including both antiplatelet drugs and anticoagulants. Concurrently, significant advances in endoscopic equipment and technology have improved the effectiveness of a broad range of diagnostic and therapeutic endoscopic procedures. However, patients receiving antithrombotic therapy are at a markedly elevated risk of bleeding during therapeutic interventions, making their careful management during endoscopic procedures a significant clinical challenge. Current Concepts: This review discusses the recent International Digestive Endoscopy Network consensus guideline on managing antithrombotic agents in patients undergoing gastrointestinal endoscopy. The guideline, developed by 36 multidisciplinary experts, including international specialists in gastroenterology, cardiology, and neurology, underscores the necessity of carefully assessing both bleeding and thromboembolic risks for each patient to determine whether, and exactly when, to withhold these medications before endoscopic procedures. Furthermore, the guideline strongly emphasizes that such decisions should always be made through close multidisciplinary collaboration. We present strategies for managing patients on antithrombotic agents before and after endoscopic procedures, categorized according to the bleeding risk associated with different endoscopic interventions. Discussion and Conclusion: This review aims to provide practical guidance for clinicians who manage patients on antithrombotic therapy requiring diagnostic or elective therapeutic endoscopy. Depending on the bleeding risk of the procedure and individual patient factors, including the risk of thromboembolism, antithrombotic agents should be adjusted appropriately before and after the procedure.