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Gastrointestinal Endoscopy in Patients on Direct Oral Anticoagulants. A Consensus Paper of the Romanian Society of Gastroenterology and Hepatology

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Andreea Farcas1, Simona Bataga2, Cristina Cijevschi3, Mircea Diculescu4, Daniela Dobru2, Eugen Dumitru5, Adrian Goldis7, Laurentiu Nedelcu6, Alina Popescu7, Ioan Sporea7, Anca Trifan3, Simona Valean8, Cristian Gheorghe4, Dan Lucian Dumitrascu9

1) Drug Information Research Center, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca;
2) Gastroenterology Department, University of Medicine and Pharmacy, Târgu-Mureș;
3) Institute of Gastroenterology and Hepatology, Grigore T. Popa University of Medicine and Pharmacy, Iași;
4) Center of Gastroenterology and Hepatology Fundeni, Carol Davila University of Medicine and Pharmacy. Bucharest;
5) Faculty of Medicine, Ovidius University of Constanța;
6) Department of Internal Medicine, Transilvania University, Brasov;
7) Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara; 8) 1st Medical Clinic, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca;
9) 2nd Medical Department Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.272.end

Management of patients undergoing endoscopy and under treatment with the newer direct oral anticoagulants (DOACs) is a common and a complex clinical issue that gastroenterologists have to face more and more often these days. The increasing use of DOACs in patients requiring both short- and long-term anticoagulation is mostly due to the advantages these agents offer, among which the lack of monitoring requirements and the reduced need of dose adjustments are perhaps the most important ones. Managing these patients in the peri-endoscopic period implies balancing the risk for thrombosis that a certain patient carries and the bleeding risk associated with the endoscopic procedure itself. The Romanian Society of Gastroenterology and Hepatology decided to create a consensus paper to serve to practitioners and teachers. After reviewing the available published data and existing recommendations, a Delphi consensus process was carried out involving the leaders of opinion in this field. After reaching expert consensus, we provide herein guidance for a practical approach of DOACs therapy management in patients with endoscopic interventions.
Key words: direct oral anticoagulants – endoscopy – therapy management.
Abbreviations: APTT: activated partial thromboplastin time; ASA: acetylsalicylic acid; CrCl: creatinine clearance; DOACs: direct oral anticoagulants; EMA: European Medicines Agency; EMR/ESD: endoscopic mucosal resection/endoscopic submucosal dissection; ERCP: endoscopic retrograde cholangiopancreatography; EUS: endoscopic ultrasound; FNA: fine-needle aspiration; GIB: gastrointestinal bleeding; H2RAs: histamine H2: receptor antagonists; NOACs: non-vitamin K oral anticoagulants; NSAIDs: non-steroidal antiinflammatory drugs; PCC: prothrombin complex concentrates; PEG: percutaneous endoscopic gastrostomy; PEJ: percutaneous endoscopic jejunostomy; P-gp: P-glycoprotein; PPIs: proton pump inhibitors; PT: prothrombin time; RCTs: randomized clinical trials; VKAs: vitamin K antagonists.