Summary: he risk of endoscopy in patients on antithrombotic agents depends on the risk of procedural hemorrhage and thrombosis due to discontinuation of therapy.
According to the British Society of Gastroenterology and the European Society of Gastrointestinal Endoscopy, continuation of single or dual antiplatelet therapy is recommended for low-risk endoscopic procedures. For high-risk procedures in patients at low thrombotic risk, P2Y12 antagonists should be discontinued five days before an endoscopy, while for patients at high thrombotic risk it should be discussed with a cardiologist.
Similarly, warfarin therapy should be continued for low-risk endoscopic procedures, temporarily discontinued five days before high-risk procedures in patients at low thrombotic risk, and possibly substituted with low molecular weight heparin in patients at high thrombotic risk.
For low-risk procedures, omission of the morning dose of DOAC on the day of an endoscopy is suggested. The last dose of DOAC for patients undergoing high-risk procedures should be taken ≥ 48 hours before an endoscopy.