GASTROINTESTINAL ENDOSCOPY IN PATIENTS TAKING ANTIPLATELET AGENTS ANDANTICOAGULANTS - SURVEY OF ASGE MEMBERS

Background: Gastrointestinal endoscopy is often required in patients t aking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or antic oagulants. Because proper guidelines are lacking, we believe that most endoscopists use their own criteria and judgment for stopping and res tarting these agents during the periendoscopic period, and the practic e varies widely. The aim of our study was to identify these practices among ASGE members. Methods: Questionnaires, each containing 22 questi ons with 157 responses, were sent to 3300 ASGE members, including all Gastroenterology Fellowship Program Directors. One thousand two hundre d sixty-nine questionnaires were received and analyzed. Results: Physi cians stopped aspirin and NSAIDs more frequently before colonoscopy (8 1%) and ERCP (79%) than before upper endoscopy (51%) (p < 0.001). Nine ty percent of physicians stopped aspirin and NSAIDs for 10 or fewer da ys. Only 20% of physicians performed sphincterotomy when aspirin and N SAIDs were not stopped compared with 88% and 85% (p < 0.001 for both) of physicians performing cold biopsies at esophagogastroduodenoscopy a nd colonoscopy, respectively, and 77% and 69% performing hot biopsies for the same procedures (p < 0.001 for all compared with sphincterotom y). Depending on the indication for anticoagulation, 51% to 60% of phy sicians stopped warfarin before upper endoscopy; 71% to 82% before col onoscopy; and 26% to 51% of physicians used a ''heparin window.'' All physicians restarted warfarin immediately after diagnostic endoscopy, whereas 80% restarted it 7 or fewer days after therapeutic endoscopy. Conclusions: We conclude that a wide variation exists regarding the ma nagement of aspirin, NSAIDs, and anticoagulants in the periendoscopic period. There is a definite need for a consensus statement or guidelin es for managing patients taking these agents.