Guidelines of the French Society for Digestive Endoscopy (SFED)

 

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Managing patients who are taking Vitamin K Antagonists (VKA) or antiplatelet agents (APA) is a common problem before performing digestive endoscopy. Although risks concerning bleeding are the remit of both the gastroenterologist and anaesthetist, the potential risk of interruption of antithrombotic treatment for the patient should not be underestimated. Faced with the wide variety of situations, it is difficult to lay down rules which cover all circumstances and there are few reference guidelines [1] [2] [3]. Ideally, changes of treatment ought to be made in consultation with the doctor who initially prescribed the treatment with estimation of the risk/benefit ratio bearing in mind alterations to the antithrombotic treatment. This has to be tailored to individual patients on a case-by-case basis.This ideal situation is rare. Often the patient cannot remember the reference physician or the latter cannot be contacted. Other factors rendering such strategies difficult and complex include differences of opinion or lack of knowledge about the respective risks of stopping antithrombotic treatment or of not performing the endoscopy, lack of data in the literature, etc. However, in practice there are some data on which to base a decision. Three factors should be taken into account: the risk of haemorrhage from the procedure, the antithrombotic treatment used and the risk of thromboembolism when the treatment is withdrawn. In an attempt to reach the broadest possible consensus, the French Society of Digestive Endoscopy (SFED), the Study Group on Haemostasis and Thrombosis (GEHT) of the French Society of Haematology, the French Society of Cardiology (SFC) and the French Society of Anaesthesiology and Intensive Care Medicine (SFAR) have joined forces and put forward these recommendations. Of course, they are still only temporary guidelines and are likely to change over time as scientific knowledge accrues.

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Dr. B. Napoleon

Société Française d’Endoscopie Digestive (SFED)

35 rue Bataille · 69008 Lyon · France ·

Phone: +33-478-78-10-51

Fax: +33-478-74-07-92

Email: bertrand.napoleon@libertysurf.fr