Clinical practice of the management of antithrombotic therapy in gastrointestinal endoscopy

The need for gastrointestinal (GI) endoscopy for patients under antithrombotic therapy has recently been increasing. The Guidelines for antithrombotic therapy in GI endoscopy is different between Japan and Western countries. We investigated the clinical practice of the management of antithrombotic therapy and the frequency of bleeding and thrombo-embolism in GI endoscopy. About 80% of the endoscopists had performed an invasive procedure for the patients under antithrombotic therapy. In a half of them the problems were caused by operator error. After an invasive procedure, half of the endoscopists prescribed antiulcerative medication, and 20% of the endoscopists had performed endoscopic preventive hemostasis. No GI bleeding occurred in this investigation. However, 10 thrombo-embolic events occurred during cessation of the antithrombotic therapy. Antithrombotic therapy should be stopped with exact assessment and informed consent. Furthermore, evidence in Japanese patients established by the Japan Gastroenterological Endoscopy Society is required.