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 journalArticle

15 Citations (Scopus)

Abstract

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)
Volume26
Issue number9
DOIs
Publication statusPublished - 2011
Externally publishedYes

Fingerprint

Fibrinolytic Agents
Japan
Endoscopy
Guidelines
Confidence Intervals
Digestive System Endoscopy
Colonoscopy
Ventricular Tachycardia
Cohort Studies
Outpatients
Outcome Assessment (Health Care)
Prospective Studies
Hemorrhage
Biopsy

Keywords

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

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Conflicting clinical environment about the management of antithrombotic agents during the periendoscopic period in Japan. / Ono, Satoshi; Fujishiro, Mitsuhiro; Kanzaki, Hiromitsu; Uedo, Noriya; Yokoi, Chizu; Akiyama, Junichi; Sugawara, Masaki; Oda, Ichiro; Suzuki, Shoko; Fujita, Yoshiyuki; Tsubata, Shunsuke; Hirano, Masaaki; Fukuzawa, Masakatsu; Kataoka, Mikinori; Kamoshida, Toshiro; Hirai, Shinji; Sumiyoshi, Tetsuya; Kondo, Hitoshi; Yamamoto, Yorimasa; Okada, Kazuhisa; Morita, Yoshinori; Fujiwara, Shoko; Morishita, Shinji; Matsumoto, Masao; Koike, Kazuhiko.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 26, No. 9, 2011, p. 1434-1440.

Research output: Contribution to journalArticle

Ono, S, Fujishiro, M, Kanzaki, H, Uedo, N, Yokoi, C, Akiyama, J, Sugawara, M, Oda, I, Suzuki, S, Fujita, Y, Tsubata, S, Hirano, M, Fukuzawa, M, Kataoka, M, Kamoshida, T, Hirai, S, Sumiyoshi, T, Kondo, H, Yamamoto, Y, Okada, K, Morita, Y, Fujiwara, S, Morishita, S, Matsumoto, M & Koike, K 2011, 'Conflicting clinical environment about the management of antithrombotic agents during the periendoscopic period in Japan', Journal of Gastroenterology and Hepatology (Australia), vol. 26, no. 9, pp. 1434-1440. https://doi.org/10.1111/j.1440-1746.2011.06761.x
Ono, Satoshi ; Fujishiro, Mitsuhiro ; Kanzaki, Hiromitsu ; Uedo, Noriya ; Yokoi, Chizu ; Akiyama, Junichi ; Sugawara, Masaki ; Oda, Ichiro ; Suzuki, Shoko ; Fujita, Yoshiyuki ; Tsubata, Shunsuke ; Hirano, Masaaki ; Fukuzawa, Masakatsu ; Kataoka, Mikinori ; Kamoshida, Toshiro ; Hirai, Shinji ; Sumiyoshi, Tetsuya ; Kondo, Hitoshi ; Yamamoto, Yorimasa ; Okada, Kazuhisa ; Morita, Yoshinori ; Fujiwara, Shoko ; Morishita, Shinji ; Matsumoto, Masao ; Koike, Kazuhiko. / Conflicting clinical environment about the management of antithrombotic agents during the periendoscopic period in Japan. In: Journal of Gastroenterology and Hepatology (Australia). 2011 ; Vol. 26, No. 9. pp. 1434-1440.
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abstract = "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.",
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T1 - Conflicting clinical environment about the management of antithrombotic agents during the periendoscopic period in Japan

AU - Ono, Satoshi

AU - Fujishiro, Mitsuhiro

AU - Kanzaki, Hiromitsu

AU - Uedo, Noriya

AU - Yokoi, Chizu

AU - Akiyama, Junichi

AU - Sugawara, Masaki

AU - Oda, Ichiro

AU - Suzuki, Shoko

AU - Fujita, Yoshiyuki

AU - Tsubata, Shunsuke

AU - Hirano, Masaaki

AU - Fukuzawa, Masakatsu

AU - Kataoka, Mikinori

AU - Kamoshida, Toshiro

AU - Hirai, Shinji

AU - Sumiyoshi, Tetsuya

AU - Kondo, Hitoshi

AU - Yamamoto, Yorimasa

AU - Okada, Kazuhisa

AU - Morita, Yoshinori

AU - Fujiwara, Shoko

AU - Morishita, Shinji

AU - Matsumoto, Masao

AU - Koike, Kazuhiko

PY - 2011

Y1 - 2011

N2 - 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.

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KW - Anticoagulant

KW - Antiplatelet agent

KW - Bleeding

KW - Cerebrovascular and cardiovascular disease

KW - Complication

KW - Endoscopy

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