English summaries
Bleeding risk in connection with gastrointestinal endoscopy and endoscopic procedures
Julkaistu 07.05.2010 00.01
The risk of acute haemorrhage after gastrointestinal endoscopy and biopsy is usually low. Endoscopic procedures such as polypectomy and dilatation of strictures increase the likelihood of overt bleeding, especially in patients with anticoagulant or antiplatelet drug therapy. On the other hand, the discontinuation of these drugs may result in thrombotic complications. Aspirin withdrawal is usually not necessary before endoscopy, provided that there are no other risk factors present. In procedures with a low risk of bleeding antithrombotic treatment can usually be continued, but the INR level should be checked prior to the procedure, whereas in high-risk procedures, warfarin and clopidogrel should be temporarily discontinued. However, if the risk of thrombosis after stopping antithrombotic therapy outweighs the risk of haemorrhage, warfarin should be temporarily replaced by low molecular weight heparin (bridge therapy). Discontinuation of clopidogrel therapy is not safe within six weeks to three months after placement of bare metal coronary stent and within 12 months after placement of drug-eluting coronary stent; clopidogrel withdrawal should thus be considered only after consulting the cardiologist. Discussion with the haematologist is necessary if the patient suffers from von Willebrand’s disease or from haemophilia.
Co-existing liver failure or uraemia increases the bleeding risk, and heart failure, atrial fibrillation or previous thromboembolic complication or stroke increases the risk of thrombosis, if antithrombotic therapy is discontinued. The medical condition of the patient should be assessed on an individual basis when weighing up the benefits and risks of gastrointestinal endoscopic procedures.
Pekka Collin
Docent, Head of Department
Tampere University Hospital, Department of Gastroenterology
Markku Peräaho, Martti Färkkilä, Markku Heikkinen, Rauli Leino, Seppo Niemelä
Finnish Medical Journal 2010;65:1613–6.
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