Tag: Endoscopy

High-risk procedures in patients with very high-risk conditions If the procedure cannot be delayed, warfarin therapy should be discontinued four to five days before the procedure, and a heparin infusion should be administered as soon as the INR falls below 2.0. Heparin should be stopped 6 h before the procedure and restarted within 2 to […]

Low-risk procedures No adjustment in anticoagulation is required for low-risk procedures, regardless of the underlying condition. Elective procedures should be avoided, however, when the INR is above the therapeutic range. High-risk procedures in patients with low-risk conditions In these situations, warfarin should be discontinued four to five days before the scheduled procedure, and the INR […]

In high-risk patients who undergo high-risk procedures, bridging anticoagulant therapy is required when the INR is less than 2.0. LMWHs are being increasing used, even though there has been no prospective controlled study of their safety and effectiveness for gastrointestinal procedures. They are associated with lower risks of bleeding than that with conventional (unfractionated) heparin, […]

Most bleeding that occurs after an endoscopic procedure is immediate, and results from inadequate hemostasis. In more than 80% of cases of bleeding, the diagnosis is made within 48 h of the procedure. Most of the remainder of bleeding episodes occur within the next 10 days. Some studies have found that severe acute bleeding from […]

In patients with a hereditary hypercoagulable state or active cancer, discontinuation of warfarin is reported to be associated with a risk of thromboembolism of 15% per year. The consequences of VTE are significant. The risk of pulmonary embolism is 6.4% within the first two weeks after surgery in patients with a history of VTE. It […]

The average rate of major thromboembolism in patients with mechanical heart valves is 8% per year without treatment, and is reduced by 75% by anticoagulant therapy. The complication rate is less in patients with the newer generation of aortic valve prostheses. In patients with these prosthe-ses, even if the international normalized ratio (INR) is subtherapeutic […]

Several conditions are associated with an increased likelihood of thromboembolism (Table 2). The risks for some of these are well known. On the other hand, anticoagulation regimens for patients with hypercoagulable states and some types of vascular grafts have not been standardized, and decisions should be made on an individual basis. TABLE 2 Risk of […]

Anticoagulants and antiplatelet agents are increasingly employed for primary and secondary prophylaxis of cardiovascular and cerebrovascular thromboembolic disease and venous thromboembolism. Therapeutic endoscopy is also evolving and becoming more widely used. The management of anticoagulation during endoscopy is complex, because a wide variety of clinical situations need to be considered. This might explain why the […]

Lower gastrointestinal bleeding remains a difficult diagnostic and therapeutic problem. Most patients have lower gastrointestinal bleeding that stops spontaneously. These patients can be investigated by colonoscopy over the 24 to 48 h following a standard colonic preparation. For the 15% of patients whose bleeding continues, identification of the bleeding site is critical for subsequent management. […]

Overall, 25% of patients require a surgical procedure, usually for persistent hemorrhage resulting in hemodynamic instability. Provided that the site of bleeding has been accurately located by colonoscopy or angiogram, directed segmental resection results in low morbidity (0% to 13%) and is highly successful in stopping bleeding (85% to 99%). Every attempt, including intraoperative endoscopy, […]