The periprocedural management of patients on a direct oral anticoagulant undergoing an elective gastrointestinal endoscopic procedure

Abstract

This narrative review summarizes the current body of literature regarding the periprocedural management of direct anticoagulants (DOACs) for patients undergoing digestive endoscopy since the publication of the 2022 American College of Gastroenterology – Canadian Association of Gastroenterology guidelines. We provide a detailed analysis of TE risk, endoscopic procedure-specific bleeding risks, contemporary intra-procedural techniques to reduce bleeding risk, and a summary of major gastrointestinal societies’ periprocedural DOAC guidelines, including procedure risk stratification. While there exists heterogeneity in the data, the overall trend of the current literature supports the contemporary practice of a minimal DOAC interruption without the need for heparin bridging.