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Antiplatelets and anticoagulants reduce the risk of venous thromboembolism in high-risk patients. However, when these patients need gastrointestinal procedures like endoscopy, these agents increase the risk of bleeding related to the procedure. This activity reviews an interprofessional approach to holding antithrombotic therapy before different gastrointestinal procedures and the resumption following the same. Objectives: Identify the risk of bleeding associated with different gastrointestinal procedures. Evaluate the risks of thromboembolism in different medical conditions. Determine the approach to managing anticoagulants and antiplatelets before elective gastrointestinal procedures. Describe the interprofessional team approach to managing bleeding risks associated with antithrombotic agents in patients undergoing emergent endoscopy. Access free multiple choice questions on this topic.

Antithrombotic therapy, including antiplatelet and anticoagulants, is used to reduce the risk of thromboembolic episodes in patients with medical conditions like coronary artery disease, cerebrovascular accidents, peripheral arterial disease, atrial fibrillation, venous thromboembolism, hypercoagulable states, and mechanical heart valves among others. These agents increase the bleeding risk when undertaking endoscopic procedures, but there is also a risk of thromboembolic sequelae if they are withheld. The strategy for managing this therapy when these patients need gastrointestinal endoscopic procedures has been controversial. In this chapter, we discuss this based on the available evidence and the current guidelines.[1][2][3] The 2 vital factors to be considered while performing an endoscopic procedure in a patient on these agents are the risk of bleeding associated with the procedure and the risk of thromboembolism associated with the underlying medical condition for which the agents are being used.

Healthcare providers must educate patients on the importance of holding these medications for a specific duration before the procedure and on their prompt resumption. This counsel is possible through direct counseling, educational materials, and the use of technology to send reminders. The interprofessional team must discuss the potential risks and benefits of this strategy with patients. This interprofessional approach is vital in ensuring an appropriate treatment plan. In addition to the specialists, surgeons, and other clinicians, nurses monitor the patient following the procedure. A board-certified pharmacotherapy pharmacist can consult with the clinicians to stop and resume anticoagulation therapy surrounding the procedure. A patient-centered interprofessional team consisting of the primary care provider, gastroenterologist, cardiologist, or hematologist, pharmacists, and nurses have to be involved in guiding patients on handling the change in their medication regimen, monitoring for bleeding, titration of therapy, and early recognition of any complications should they occur. This team paradigm positively drives patient outcomes.