Emergency endoscopic procedures in patients using antithrombotic therapy

Detailed management of antithrombotic therapy in patients with acute gastrointestinal bleeding is beyond the scope of these guidelines. In general, antithrombotic therapy should be withheld until haemostasis is achieved, then restarted as soon as possibleChan, 2018. An exception is the use of dual antiplatelet therapy in patients who have had a drug-eluting stent inserted within the previous 12 months—in this case the drugs should be continued if possibleChan, 2018.

For emergency procedures, rapid reversal of anticoagulant therapy may be required; see information on the reversal of warfarin, dabigatran or unfractionated heparin. At the time of writing, no specific reversal agent is available for apixaban or rivaroxaban. Seek expert advice from a haematologist.