Antithrombotic therapy, including antiplatelet and anticoagulants, is used to reduce the risk of thromboembolic episodes in patients with medical conditions like coronary artery disease (CAD), cerebrovascular accidents (CVA), peripheral arterial disease (PAD), atrial fibrillation (AF), venous thromboembolism (VTE), hypercoagulable states, and mechanical heart valves among others. These agents increase the bleeding risk when undertaking endoscopic procedures, but there is also a risk of thromboembolic sequelae if they are withheld. The strategy for managing this therapy when these patients need gastrointestinal (GI) endoscopic procedures has been a subject of controversy. In this chapter, we discuss this based on the available evidence and the current guidelines. The two vital factors to be considered while performing an endoscopic procedure in a patient on these agents is the risk of bleeding associated with the procedure and the risk of thromboembolism associated with the underlying medical condition for which the agents are being used.
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