Conflicting clinical environment about the management of antithrombotic agents during the periendoscopic period in Japan

Satoshi Ono, Mitsuhiro Fujishiro, Hiromitsu Kanzaki, Noriya Uedo, Chizu Yokoi, Junichi Akiyama, Masaki Sugawara, Ichiro Oda, Shoko Suzuki, Yoshiyuki Fujita, Shunsuke Tsubata, Masaaki Hirano, Masakatsu Fukuzawa, Mikinori Kataoka, Toshiro Kamoshida, Shinji Hirai, Tetsuya Sumiyoshi, Hitoshi Kondo, Yorimasa Yamamoto, Kazuhisa OkadaYoshinori Morita, Shoko Fujiwara, Shinji Morishita, Masao Matsumoto, Kazuhiko Koike

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Background and Aims: Although there are guidelines for the management of antithrombotic agents during the periendoscopic period, gaps between various guidelines create a confusing situation in daily clinical practice. The purpose of this study was to examine the current management of antithrombotic agents during the periendoscopic period in Japan. Methods: This is a prospective cohort study in 12 high-volume endoscopy centers in Japan. A total of 970 outpatients receiving antithrombotic agents underwent endoscopies (705 esophagogastroduodenoscopies and 265 colonoscopies) with or without invasive procedures. Main outcome measures are adverse events in these patients. Results: Need for cessation of antithrombotics before endoscopy was mostly determined by non-gastroenterologists (51%) who are unfamiliar with the Japan Gastroenterological Endoscopy Society (JGES) guideline, although cessation periods after endoscopy for most patients were determined by endoscopists (78%). Consequently, most patients underwent endoscopy without cessation (25%) or after a cessation period of 6-7days (33%), indicating low permeation of the JGES guideline in Japan. Among 970 patients, two patients experienced major complications that may be related to thromboembolic events or gastrointestinal bleeding (95% confidence interval [CI]: 0-0.7%). One of these patients died due to sudden onset ventricular tachycardia. Invasive procedures, including 40 biopsies and two mucosal resections, were performed in 42 patients without cessation of antithrombotics, and no patients experienced major complications (95% CI: 0-8.4%). Conclusions: This study revealed a conflicting clinical environment due to absence of a unified guideline in Japan. Further accumulation of data is mandatory to establish a unified guideline based upon solid evidence.

Original languageEnglish
Pages (from-to)1434-1440
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Issue number9
Publication statusPublished - Sept 2011
Externally publishedYes


  • Anticoagulant
  • Antiplatelet agent
  • Bleeding
  • Cerebrovascular and cardiovascular disease
  • Complication
  • Endoscopy

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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