Hey Devil lady, here ya go, knock yourself out!
http://www.asge.org/nspages/practice/patientcare/sop/preparation/2002_antiCoag.pdf
RECOMMENDATIONS
The decision to reverse anticoagulation, risking
thromboembolic consequences, must be weighed
against the risk of continued bleeding by maintaining
the anticoagulated state. The degree of reversal
of anticoagulation should be individualized. A
supratherapeutic INR may be treated with fresh
frozen plasma. In one series, correction of the INR to
1.5 to 2.5 allowed successful endoscopic diagnosis
and therapy at rates comparable with those
achieved in nonanticoagulated patients.3 In contrast
to the use of fresh frozen plasma, the administration
of vitamin K has a delayed onset of action, and prolongs
the time required to re-establish therapeutic
anticoagulation.4
After appropriate endoscopic management, it is
generally safe to reinstitute warfarin therapy within
a few days. In a series of 27 patients who developed
gastrointestinal bleeding while on warfarin, there
was one episode of thromboembolism after withdrawal
of anticoagulation for a median of 4 days and
no subsequent bleeding after reinstitution of antico-
agulation.5 When rapid resumption of anticoagulation
is desired, intravenous heparin should be used.
http://www.asge.org/nspages/practice/patientcare/sop/preparation/2005_heparin.pdf
Gastroenterology Service, Brooke Army Medical Center, San Antonio, Texas 78234-6200, USA.
BACKGROUND: Gastrointestinal endoscopy is often required in patients taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or anticoagulants. Because proper guidelines are lacking, we believe that most endoscopists use their own criteria and judgment for stopping and restarting these agents during the periendoscopic period, and the practice varies widely. The aim of our study was to identify these practices among ASGE members. METHODS: Questionnaires, each containing 22 questions with 157 responses, were sent to 3300 ASGE members, including all Gastroenterology Fellowship Program Directors. One thousand two hundred sixty-nine questionnaires were received and analyzed. RESULTS: Physicians stopped aspirin and NSAIDs more frequently before colonoscopy (81%) and ERCP (79%) than before upper endoscopy (51%) (p < 0.001). Ninety percent of physicians stopped aspirin and NSAIDs for 10 or fewer days. Only 20% of physicians performed sphincterotomy when aspirin and NSAIDs were not stopped compared with 88% and 85% (p < 0.001 for both) of physicians performing cold biopsies at esophagogastroduodenoscopy and colonoscopy, respectively, and 77% and 69% performing hot biopsies for the same procedures (p < 0.001 for all compared with sphincterotomy). Depending on the indication for anticoagulation, 51% to 60% of physicians stopped warfarin before upper endoscopy; 71% to 82% before colonoscopy; and 26% to 51% of physicians used a "heparin window." All physicians restarted warfarin immediately after diagnostic endoscopy, whereas 80% restarted it 7 or fewer days after therapeutic endoscopy. CONCLUSIONS: We conclude that a wide variation exists regarding the management of aspirin, NSAIDs, and anticoagulants in the periendoscopic period. There is a definite need for a consensus statement or guidelines for managing patients taking these agents.
PMID: 8885352 [PubMed - indexed for MEDLINE]
