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Vitamine K Antagonist and Colonoscopy: Proposal to Get out of a Dilemma

Received: 4 November 2022     Accepted: 18 November 2022     Published: 31 January 2023
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Abstract

The management of anticoagulants in patients requiring digestive endoscopy, and particularly VKA, is not always easy. There is indeed often a discrepancy between the recommendations of leaned societies and practice in the conduct of VKA treatment before a screening colonoscopy. The recommendations take into account the haemorrhagic risk of the endoscopic procedure and the nature and importance of the thrombotic risk for which the patient is under treatment. A colonoscopy with or without a biopsy is considered a low bleeding risk procedure for which it is recommended not to stop VKA treatment. If the examination reveals a lesion, the resection gesture will be programmed in a second time after stopping the AVK which will possibly be substituted by a Low molecular weight heparin according to a very precise schedule. In practice, this recommendation is poorly followed, because the continuation of VKA does not allow to carry out simultaneously a diagnostic and therapeutic gesture and sometimes imposes an overload of work. Its systematic stopping is also not the right solution, because it often consists of unnecessary thromboembolic risk taking. To resolve this dilemma, we propose to decide whether to discontinue VKA treatment based on the level of risk of adenoma and colorectal cancer.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)
DOI 10.11648/j.ijacm.20231101.11
Page(s) 1-4
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Colonoscopy, VKA, Risk of Adenoma, Kaminski Score

References
[1] Veitch AM, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Endoscopy. 2021; 53: 947-969.
[2] Deutsch D, Boustière C. Endoscopie digestive et gestion des patients sous antithrombotiques oraux. Hépato-Gastro et Oncologie Digestive. 2021; 28: 267-274.
[3] Feagins LA. Management of Anticoagulants and Antiplatelet Agents During Colonoscopy. Am J Med. 2017 Jul; 130 (7): 786-795.
[4] De Santiago ER. Endoscopy-Related Bleeding and Thromboembolic Events in Patients on Direct Oral Anticoagulants or Vitamin K Antagonists. Clinical Gastroenterology and Hepatology. Published: December 03, 2020. DOI: https://doi.org/10.1016/.
[5] Bruno M, Marengo A, Elia C, Caronna S et al. Antiplatelet and anticoagulant drugs management before gastrointestinal endoscopy: Do clinicians adhere to current guidelines? Digestive and Liver Disease. 2015; 47: 45-49.
[6] Doorey AJ, Schwartz WS. Should Procedures or Patients Be Safe? Bias in Recommendations for Periprocedural Discontinuation of Anticoagulation. Mayo Clinic Proceedings. Volume 93, Issue 9, September 2018, Pages 1173-1176.
[7] Boustiere C, Veitch A, Vanbiervliet G et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2011; 43: 445-461.
[8] Telford JJ, Abraham NS. Management of Antiplatelet and Anticoagulant Agents before and after Polypectomy. Gastrointest Endosc Clin N Am. 2022 Apr; 32 (2): 299-312.
[9] Neena SA. Antiplatelets, anticoagulants, and colonoscopic polypectomy. Gastrointestinal Endoscopy. Volume 91, Issue 2, February 2020, Pages 257-265.
[10] Kim HG, Friedland S. Safe and effective colon polypectomy in patients receiving uninterrupted anticoagulation: can we do it? Gastrointestinal Endoscopy. 2014; 79 (3): 424-426.
[11] Kato M, Uedo N, Hokimoto S et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment: 2017 appendix on anticoagulants including direct oral anticoagulants. Dig Endosc. 2018; 30: 433-440.
[12] Nutalapati V et al. Development and validation of a web-based electronic application in managing antithrombotic agents in patients undergoing GI endoscopy. Gastrointestinal Endoscopy. 2019; 90 (6), 906-912.
[13] Doorey AJ, Weintraub WS, Schwartz JS. Should Procedures or Patients Be Safe? Bias in Recommendations for Periprocedural Discontinuation of Anticoagulation. Mayo Clinic Proceedings. 2018-09-01, Volume 93, Numéro 9, Pages 1173-1176.
[14] Kaminski MF, Polkowski M, Kraszewska E et al. A score to estimate the likelihood of detecting advanced colorectal neoplasia at colonoscopy. Gut. 2014; 63: 1112-1119.
[15] Heresbach D, Pienkowski P, Chaussade S et al. Prévention du cancer colorectal par coloscopie, en dehors du dépistage en population. Consensus et position de la SFED. Acta Endosc. 2016; 46: 68-73.
Cite This Article
  • APA Style

    Mohamed Karim Abdessalem, Sophie Dufraisse, Julie Demas, Martine Beurdeley, Hélène Ribier. (2023). Vitamine K Antagonist and Colonoscopy: Proposal to Get out of a Dilemma. International Journal of Anesthesia and Clinical Medicine, 11(1), 1-4. https://doi.org/10.11648/j.ijacm.20231101.11

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    ACS Style

    Mohamed Karim Abdessalem; Sophie Dufraisse; Julie Demas; Martine Beurdeley; Hélène Ribier. Vitamine K Antagonist and Colonoscopy: Proposal to Get out of a Dilemma. Int. J. Anesth. Clin. Med. 2023, 11(1), 1-4. doi: 10.11648/j.ijacm.20231101.11

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    AMA Style

    Mohamed Karim Abdessalem, Sophie Dufraisse, Julie Demas, Martine Beurdeley, Hélène Ribier. Vitamine K Antagonist and Colonoscopy: Proposal to Get out of a Dilemma. Int J Anesth Clin Med. 2023;11(1):1-4. doi: 10.11648/j.ijacm.20231101.11

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  • @article{10.11648/j.ijacm.20231101.11,
      author = {Mohamed Karim Abdessalem and Sophie Dufraisse and Julie Demas and Martine Beurdeley and Hélène Ribier},
      title = {Vitamine K Antagonist and Colonoscopy: Proposal to Get out of a Dilemma},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {11},
      number = {1},
      pages = {1-4},
      doi = {10.11648/j.ijacm.20231101.11},
      url = {https://doi.org/10.11648/j.ijacm.20231101.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20231101.11},
      abstract = {The management of anticoagulants in patients requiring digestive endoscopy, and particularly VKA, is not always easy. There is indeed often a discrepancy between the recommendations of leaned societies and practice in the conduct of VKA treatment before a screening colonoscopy. The recommendations take into account the haemorrhagic risk of the endoscopic procedure and the nature and importance of the thrombotic risk for which the patient is under treatment. A colonoscopy with or without a biopsy is considered a low bleeding risk procedure for which it is recommended not to stop VKA treatment. If the examination reveals a lesion, the resection gesture will be programmed in a second time after stopping the AVK which will possibly be substituted by a Low molecular weight heparin according to a very precise schedule. In practice, this recommendation is poorly followed, because the continuation of VKA does not allow to carry out simultaneously a diagnostic and therapeutic gesture and sometimes imposes an overload of work. Its systematic stopping is also not the right solution, because it often consists of unnecessary thromboembolic risk taking. To resolve this dilemma, we propose to decide whether to discontinue VKA treatment based on the level of risk of adenoma and colorectal cancer.},
     year = {2023}
    }
    

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    AU  - Mohamed Karim Abdessalem
    AU  - Sophie Dufraisse
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    DO  - 10.11648/j.ijacm.20231101.11
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    JO  - International Journal of Anesthesia and Clinical Medicine
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    PB  - Science Publishing Group
    SN  - 2997-2698
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    AB  - The management of anticoagulants in patients requiring digestive endoscopy, and particularly VKA, is not always easy. There is indeed often a discrepancy between the recommendations of leaned societies and practice in the conduct of VKA treatment before a screening colonoscopy. The recommendations take into account the haemorrhagic risk of the endoscopic procedure and the nature and importance of the thrombotic risk for which the patient is under treatment. A colonoscopy with or without a biopsy is considered a low bleeding risk procedure for which it is recommended not to stop VKA treatment. If the examination reveals a lesion, the resection gesture will be programmed in a second time after stopping the AVK which will possibly be substituted by a Low molecular weight heparin according to a very precise schedule. In practice, this recommendation is poorly followed, because the continuation of VKA does not allow to carry out simultaneously a diagnostic and therapeutic gesture and sometimes imposes an overload of work. Its systematic stopping is also not the right solution, because it often consists of unnecessary thromboembolic risk taking. To resolve this dilemma, we propose to decide whether to discontinue VKA treatment based on the level of risk of adenoma and colorectal cancer.
    VL  - 11
    IS  - 1
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Author Information
  • Anesthesia Department, Rodez Hospital, Rodez, France

  • Anesthesia Department, Rodez Hospital, Rodez, France

  • Anesthesia Department, Rodez Hospital, Rodez, France

  • Anesthesia Department, Rodez Hospital, Rodez, France

  • Anesthesia Department, Rodez Hospital, Rodez, France

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