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

Mohamed Karim Abdessalem; Sophie Dufraisse; Julie Demas; Martine Beurdeley; Hélène Ribier

doi:doi:10.11648/j.ijacm.20231101.11

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

Mohamed Karim Abdessalem, Sophie Dufraisse, Julie Demas, Martine Beurdeley, Hélène Ribier

Published in International Journal of Anesthesia and Clinical Medicine (Volume 11, Issue 1)

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

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[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.

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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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TY  - JOUR
T1  - Vitamine K Antagonist and Colonoscopy: Proposal to Get out of a Dilemma
AU  - Mohamed Karim Abdessalem
AU  - Sophie Dufraisse
AU  - Julie Demas
AU  - Martine Beurdeley
AU  - Hélène Ribier
Y1  - 2023/01/31
PY  - 2023
N1  - https://doi.org/10.11648/j.ijacm.20231101.11
DO  - 10.11648/j.ijacm.20231101.11
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 1
EP  - 4
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231101.11
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
ER  -

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Author Information

Mohamed Karim Abdessalem

Anesthesia Department, Rodez Hospital, Rodez, France
Sophie Dufraisse

Anesthesia Department, Rodez Hospital, Rodez, France
Julie Demas

Anesthesia Department, Rodez Hospital, Rodez, France
Martine Beurdeley

Anesthesia Department, Rodez Hospital, Rodez, France
Hélène Ribier

Anesthesia Department, Rodez Hospital, Rodez, France

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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

Copy | Download

@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}
}

Copy | Download

TY  - JOUR
T1  - Vitamine K Antagonist and Colonoscopy: Proposal to Get out of a Dilemma
AU  - Mohamed Karim Abdessalem
AU  - Sophie Dufraisse
AU  - Julie Demas
AU  - Martine Beurdeley
AU  - Hélène Ribier
Y1  - 2023/01/31
PY  - 2023
N1  - https://doi.org/10.11648/j.ijacm.20231101.11
DO  - 10.11648/j.ijacm.20231101.11
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 1
EP  - 4
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20231101.11
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
ER  -

Copy | Download