EP 682 Antiplatelet and Anticoagulant Management in Endoscopy

Abstract

Antiplatelets and anticoagulants are commonly encountered in patients undergoing endoscopic procedures. While these increase bleeding risk, inappropriate interruption may increase thromboembolic risk. The British Society of Gastroenterology (BSG) published updated guidance in 2021 outlining recommendations for peri-endoscopic management of these medications. We aimed to assess local compliance with these guidelines.

We conducted a retrospective cohort audit including all patients on antiplatelets and/or anticoagulants undergoing endoscopy at our unit in December 2025. Patients were identified from the endoscopy department list, and electronic patient records were reviewed. Variables include demographics, type and risk of endoscopic procedure, antithrombotic agent and indication, timing of medication interruption and documentation of post-procedure restarting instructions.

A total of 124 patients were identified (66% male, median age 73 years). 58 patients were on aspirin, 31 on P2Y12 antagonists, 38 on DOACs and 3 on warfarin. Pre-procedure compliance was 100% for aspirin, 38.7% for P2Y12 antagonists, 21.2% for DOACs and 0% for warfarin, with unnecessary interruption in low-risk procedures. Post-procedure compliance was 8.6% for aspirin, 41.9% for P2Y12 antagonists, largely due to absent or incorrect restarting instructions. Compliance for warfarin was 100% and 63.2% for DOACs.

This audit demonstrates variable compliance with the BSG guidelines, with frequent inappropriate interruption of antiplatelet and anticoagulant therapy in low-risk procedures and poor documentation of restarting instructions. We plan to raise awareness of these guidelines through summary posters, linking within local guidelines and presentation to the local unit. A re-audit is planned in 4months to assess the impact of these interventions.