Anticoagulation and Endoscopy procedures

 Source- UTD

https://www.jtcvs.org/action/showPdf?pii=S0022-5223%2818%2931859-2



Endoscopic Sphincterotomy - Risk of bleeding persist for upto 3 to 5 days after sphincterotomy

          Low to Mod risk of Thrombosis: Delay attaining therapeutic anticoagulation for 3 to 5 days after

                                                                For eg: Re-start Warfarin at day 3 / Restart DOAC at day 5

          

          High risk of Thrombosis:  Re-start Warfarin on the evening of procedure / LMWH 48H after / DOAC day 5 - UFH 24-48H post.


                   



Mechanical Heart valves:

Mechanical Mitral / Pulmonary vaalve - HIGHEST risk

Mechanical Aortic valve - low to moderate risk based on presence of concurrent stroke risk (chadvasc)


After high-risk procedure (sphincterotomy), regardless of the valve, DO NOT re-start LMWH within 48-72H after procedure!



As per Journal of Thoracic & Cardiovascular surgery guideline (2019) for non-cardiac procedures: Metallic Heart valve with no high-risk features of stroke and normal sinus rhythm is classified as LOW risk. All other metallic heart valves are high risk.


For Low risk - RE-start warfarin when tolerating oral intake and DO NOT bridge

For high risk - Re-start warfarin when tolerating oral intake, and BRIDGE 48H later (Post-op-day-2)









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