Abstract
Aim
The guidelines on the management of anticoagulation and antiplatelet therapy for endoscopic procedures were published by the Japan Gastroenterological Endoscopy Society (JGES) in 2005 and 2006. We developed and put into clinical practice a new management manual based on the JGES guidelines in our hospital last year. The aim of this study is to validate the current state of operation of this new management manual in our hospital.
Method
Eleven thousand, seven hundred and fifty cases of low risk procedures (conventional upper and lower GI endoscopies and echo-ultrasound) during the previous year in our hospital comprised the study subjects. The medical records of all these cases were investigated retrospectively to ascertain the rates of patients receiving antithrombic and antiplatelet agents, the risk assessment of thromboembolism by the prescribing physicians, the breakdown of these agents ordered to be discontinued before procedures, compliance with the cessation periods of these agents for the manual and the incidence of post-biopsy bleeding within one week of the procedure.
Result
One thousand, one hundred and twenty-seven cases (9.6%) were receiving antithrombic and antiplatelet agents among the 11750 cases. Three hundred eighty eight cases (34.4%) were assessed as being in a high risk condition for thromboembolism by the prescribing physicians. The most common high risk condition was angina pectoris (22%), followed by atrial fibrillation (16%), cerebral infarction (9.3%), postcardiac surgery (7%), and myocardial infarction (6.7%). In 497 cases who were at low risk for thromboembolism, the most common agents ordered to be discontinued before procedures were aspirin (66%), followed by eicosapentaenoic acid (13%), ticlopidine and clopidogrel (11%), warfarin (11%) and cilostazol (6%). Compliance with the cessation periods of these agents according to the manual was low with 20% of all discontinued cases. There were no cases of bleeding after biopsy for all agents.
Conclusion
In our hospital, there were no serious problem in operations over a one-year period based on a new management manual with its origins in the JGES guidelines. Although we believe that the JGES guidelines are for the most part suitable for the current practice of endoscopic procedures in Japan, our revision of the JGES guidelines is preferable for the management of screening endoscopic procedures.
