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National survey of anticoagulation policy in endoscopy

2007; Lippincott Williams & Wilkins; Volume: 19; Issue: 1 Linguagem: Inglês

10.1097/meg.0b013e3280120eb5

1473-5687

Anurag Goel, Cara J. Barnes, Hisham Osman, Ashwin Verma,

Pancreatic and Hepatic Oncology Research

Background Anticoagulated patients who need to undergo endoscopy present unique challenges to the gastroenterologist. The continuation of anticoagulant therapy increases the risk of haemorrhagic complications of gastrointestinal endoscopy. Reversing the anticoagulation increases the risk of thromboembolism. In our experience in various endoscopy units, there are variable policies on the management of anticoagulated patients undergoing gastrointestinal endoscopy. Methods To study the current practice, survey questionnaires were sent to 2320 doctors, working in 231 hospitals across the United Kingdom. Results Responses were obtained from 219 hospitals (94.8%), but only from 434 doctors (18.7%). The results show 40.8% endoscopists continued the patients on warfarin when performing a planned upper gastrointestinal endoscopy, whereas 26% stopped it; 33.2% gave varying reports, that is, they used their own judgement according to the disease for which the anticoagulant was being given. For planned lower gastrointestinal endoscopy, 48.7% doctors preferred to stop warfarin; 53.3% of the endoscopists stated that they have a policy in place at their hospital for both upper and lower gastrointestinal endoscopy in anticoagulated patients; 5.5% had a policy for upper gastrointestinal endoscopy only and 6.2% for lower gastrointestinal endoscopy only. Thirty-five per cent doctors reported that they did not have any standard policy. We compared the responses from within a hospital to see whether the doctors were uniformly aware of an existing policy in their hospital. For upper gastrointestinal endoscopy, the responses were the same (either yes or no) by 51% of the doctors, whereas they were different by 49%. For lower gastrointestinal endoscopies, the same response was given by 49% of the doctors, whereas 51% gave different answers. The poor response rate from the doctors, however, makes firm interpretation of the data difficult. Conclusions A wide variation in practice is seen across the country. A robust national guideline to streamline the endoscopy practice in anticoagulated patients is needed.