Objective: To investigate the peri-endoscopic management of antithrombotic drugs and adverse events in elderly patients un-dergoing gastrointestinal endoscopy in order to provide clinical guidance of peri-endoscopic management of antithrombotic drugs for elderly pa-tients.
Methods: Between January 1st 2008 and December 31st 2014, clinical data of 3 747 patients (aged 46~99 years, 96.1% male) who were hospitalized for elective gastrointestinal endoscopy were analyzed retrospectively. The general clinical data, cardiovascular disease and re-lated risk factors, medication, management of peri-endoscopic antithrombotics and adverse events were recorded. The differences of peri-endo-scopic adverse events including thromboembolism and bleeding between patients with different management strategies of peri-endoscopic an-tithrombotics were analyzed.
Results: The overall incidences of peri-endoscopic thromboembolism and bleeding were 2.24% and 1.89%, re-spectively. The incidences of thromboembolism and bleeding when stopping antithrombotics at 0~7 days pre-procedure were 1.87% and 2.38% respectively. The incidences of thromboembolism and bleeding when resuming antithrombotics at 2~7 days after endoscopy were 2.07% and 0.63% respectively. When discontinuing antithrombotics, the differences in peri-endoscopic thromboembolism and bleding be-tween patients who did and did not undergo low-molecular-weight heparin (LMWH) bridging therapy were not significant. The incidence of bleeding in patients who underwent LMWH bridging therapy was higher than that in patients who didn't undergo LMWH bridging therapy, but the diference was not significant.
Conclusions: Our findings suggest that cessation of antithrombotics < 7 days pre-procedures and resumption of antithrombotic agents after 2-7 days post-porcedures is optimal in elderly Chinese patients undergoing endoscopy.
Keywords: antithrombotic agents; bleeding; elderly; peri-endoscopy; thromboembolism.