Managing anticoagulation and antiplatelet medications in GI endoscopy: a survey comparing the East and the West

BackgroundAnticoagulation and antiplatelet medications may potentiate GI bleeding, and their use may lead to an increased need for a GI endoscopy. We hypothesized that there might be different practice patterns among international endoscopists.ObjectiveTo explore the differences in management practices for patients who receive anticoagulation and antiplatelet medications from Eastern and Western endoscopists.DesignInternational survey study.SettingAcademic medical centers and private clinics.SubjectsMembers of the American Society for Gastrointestinal Endoscopy (ASGE) in Eastern (Korea, Japan, China, India, Thailand, Singapore, Malaysia, and Philippines) and Western (United States and Canada) countries were invited to complete a Web-site–based questionnaire. In addition, the questionnaire was sent to university hospitals in South Korea and academic institutions in the United States.MethodsA survey was administered that contained detailed questions about the use of an endoscopy in patients on anticoagulation and antiplatelet medications.Main Outcome MeasurementsDifferent opinions and clinical practice patterns regarding the use of anticoagulation and antiplatelet medications by Eastern and Western endoscopists.ResultsA total of 105 Eastern and 106 Western endoscopists completed the survey. Western endoscopists experienced more instances of procedure-related bleeding (P = .003) and thromboembolism after withdrawal of medications (P = .016). Eastern endoscopists restarted medications later (1-3 days) than Western endoscopists after a biopsy (same day) (P < .001). Eastern endoscopists withdrew aspirin for more than 7 days before a polypectomy and then restarted it 1 to 3 days after a polypectomy, whereas Western endoscopists performed a polypectomy without withdrawing aspirin (P < .001). ASGE guidelines were followed less often by Eastern than by Western endoscopists (P < .001).LimitationsLow response rate, heterogeneity of the sample, and recall bias.ConclusionsThe opinions and clinical practice patterns for the management of anticoagulation and antiplatelet medications differed significantly between Eastern and Western endoscopists. The lack of uniformity in practice patterns suggests that more data and better education are required in the area of GI endoscopy for patients on anticoagulation and antiplatelet medications, particularly given that individual patient characteristics may be associated with unique types of complications.