Blood thinners and gastrointestinal endoscopy

Table 1 Summary of recommendations for elective endoscopic procedure

	Low-risk conditions	High-risk conditions
Low-risk procedures	Continue APA, warfarin and NOAC	Continue APA, warfarin and NOAC
	Keep INR in therapeutic range in case of warfarin	Keep INR in therapeutic range in case of warfarin
High-risk procedures	Hold thienopyridines for 5 to 7 d before the procedure. Resume theonopyridine once hemostasis is obtained In case of dual APA, hold thienopyridines for 5 to 7 d before the procedure but continue aspirin Hold warfarin 5 d before the procedure. Resume warfarin on the same day as the procedure Hold NOAC: Rivaroxaban 2 to 4 d, apixaban 2 to 4 d, edoxaban 1 d and dabigatran 2 to 6 d before the procedure depending on creatinine clearance. Resume NOAC when adequate hemostasis is obtained	Hold thienopyridines for 5 to 7 d before the procedure after discussion with the cardiologist. Resume theonopyridine once hemostasis is obtained In case of dual APA, hold thienopyridines for 5 to 7 d before the procedure but continue aspirin Delay endoscopic procedure if coronary artery stenting done and thienopyridines cannot be discontinued If the patient is on warfarin, bridge therapy with LMWH

APA: Antiplatelet agents; NOAC: Novel oral anticoagulants; LMWH: Low molecular weight heparins; INR: International normalized ratio.